Question

C. Drug toxicity D. Hyperglycemia Use this scenanio to answer the next 2 questions You are caring for a 5 year-old boy with a 4-day history of high fever and cough He is having increasing ethargy, grunting, and sleepiness. Now he is difficult to arouse and is urnresponsive to voice commands His oxygen saturation is 72% on room air and 89% when on a noretreathing oxygen mask. He has bilateral crackies. shallow respirations, with a respiratory rate of 38/min. Auscultation of the lungs reveals 32. Which assessment finding is consistent with respiratory failure in thits child? A Cough B. Fever C. Oxygen saturation D. Respiratory rate 33 ich medication would be most appropriate? A bronchodilator 8 n antibiotic iatric Advanced Life Support o 2016 American Heart Assoc am A, October 6, 2016 iMessage Dad 11/22/18 :о: F1 o: F3 F5

Answer 1

The consequence of oxygen therapy is a worsening of hypercapnia in patients, and this has long been recognized. Hypercapnia is result from reduced minute ventilation (VE) resulting from reduced hypoxic stimulus to breathe.

VE decreased, after 15 minutes was again similar to control values on room air; despite this, there was a significant rise in values that was not correlated to changes in VE, and this was attributed to increased mismatching within the lungs. this investigated using the multiple inert-gas elimination technique in patients during an exacerbation. Respiratory muscle fatigue, is also a factor, which appears to at a late stage, and reductions in ventilation may also reflect a shallower breathing pattern.

Indirect evidence is provided by an arterial blood gas samples in hospital, which found oxygen saturations above the recommended 92% in 72% of hypercapnic samples, suggesting that oxygen control is poor. Compelling of the observational data, of high-quality evidence demonstrates the benefits of titrated oxygen therapy over high-concentration oxygen.

This occurs because oxygen and carbon dioxide displace each other from the limited space within the alveoli, according to partial pressures, as described by the alveolar gas equation.

With individual paramedics of randomization, titrated oxygen therapy with the goal of maintaining saturations between 88%–92%, the standard care of high-flow oxygen delivered via face mask is administered to patients. The key to achieving levels of oxygenation is the controlled oxygen therapy, with the patient’s oxygen level monitored and the supplemental oxygen therapy titrated to achieve acceptable saturations. Titration can be achieved by altering the oxygen flow rate or administering a mixture of air and oxygen in set proportions which the patient breathes in. The patients prefer cannulas to face masks, and this improves compliance with oxygen therapy.

However, once stability is achieved, nasal cannulas with oxygen flow rates titrated to target oxygen saturations represent the simplest and most-acceptable method of administering controlled oxygen therapy.

An oxygen bag attached at high oxygen flow rates of 60%–90% can be delivered. Here, the exact flow rate is highly variable and dependent on the patient’s minute volume. The principle of controlled oxygen therapy is to target the patient’s oxygen saturations within a range. This is because the factors affecting the patient are dynamic and will change over time.

The current clinical guidance recommends that all patients with respiratory failure in the context of a diagnosis or history suggests oxygen therapy targeted to 88%–92% until hypercapnia has been excluded by arterial blood gas analysis.

We must ensure that the knowledge already available is translated into clinical practice and that best practice is followed. This will undoubtedly improve the treatment given to the patients.