Oxygen

In this lesson, we'll go over oxygen therapy, and all of its effects, including indications, precautions and contraindications, and pediatric dosages.

Oxygen is an atmospheric gas that increases the saturation of hemoglobin oxygen and when used at therapeutic concentrations, it can aid the oxygenation of certain tissues as long as the patient isn't in shock or has some other complication, like carbon monoxide poisoning. This could affect the distribution or reception of oxygen molecules within the body and its cells.

Oxygen Indications

Now let's take a look at oxygen indications.

The primary indication for the use of oxygen in PALS is the presence of hypoxemia, which would be representative of an SpO2 of less than 94 percent, severe respiratory depression or distress, as in asthma, and respiratory distress or depression, as in opioid overdose.

When you administer oxygen therapy after the return of spontaneous circulation, otherwise known as ROSC, it's important to deliver sufficient oxygenation to maintain an SpO2 that's greater than, or equal to, 94 percent.

Oxygen Precautions and Contraindications

There are few, if any, known precautions and contraindications for oxygen therapy use in the true hypoxic patient. Precautions should be based on new and ongoing research that reveals the vasoconstrictive properties that hyperoxia may produce.

If you begin to hyperoxygenate a normoxic cardiac patient, studies indicate that you might cause lower oxygen absorption and distribution to the patient's vital organs that need oxygenation.

Pediatric Dosage of Oxygen

Now let's look at the pediatric dosage of oxygen.

The appropriate dose of oxygen will be dependent on the patient's needs and unique oxygen requirements.

Oxygen therapy can be delivered via several different methods, and the percent of oxygenation will be regulated by the flow of oxygen per minute as well as the delivery adjunct you use.

When delivering oxygen via nasal cannula is indicated, you should deliver it at a rate between 2 and 6 liters per minute. If a nonrebreather mask is used, that flow rate should be increased to between 10 and 15 liters per minute.

If delivering oxygenated ventilations via a positive pressure device like a bag valve mask, in this case, the oxygen flow should be set at 15 liters per minute.

The use of basic or advanced airway adjuncts may be needed to open or maintain a patent airway in order to treat the patient effectively.

An example of this might be, if the SpO2 reads 92 percent but the patient's skin appears normal, they could have an underlying blood disorder like anemia, which can impede the cyanosis due to a lack of hemoglobin and give the inaccurate appearance of adequate oxygenation.

A Word About Identifying Respiratory Problems by Type

We'll be digging into respiratory arrest and specific upper and lower airway issues in the following Case Studies section of your ProPALS course. So, consider this a bit of a preview of things to come, but with some additional information thrown in.

Respiratory distress or failure can be classified as one or more of the following types:

• Upper airway obstruction
• Lower airway obstruction
• Lung tissue disease
• Disordered control of breathing

Respiratory issues often do not occur in isolation. A pediatric patient can have more than a single cause of respiratory distress or failure. For example, a patient might have disordered control of breathing which was caused by a head injury and then develop pneumonia (a type of lung tissue disease). A patient might also exhibit symptoms consistent with more than one class of respiratory abnormality.

Upper Airway Obstruction

Obstruction of the upper airways can occur in the nose, pharynx, or larynx. And obstructions can range from mild to severe.

The signs of upper airway obstruction include:

• An increased respiratory rate and effort
• An increased inspiratory respiratory effort (such as inspiratory retractions, the use of accessory muscles of respiration, and nasal flaring)
• Stridor (usually inspiratory but can also be expiratory)
• A change in the patient's voice, cry, or the presence of a barking cough
• Drooling, snoring, or gurgling sounds
• Poor chest rise
• Poor air entry on auscultation

Lower Airway Obstruction

Obstruction of the lower airways can occur in the lower trachea, the bronchi, or the bronchioles.

The signs of lower airway obstruction include:

• An increased respiratory rate
• An increased respiratory effort (such as retractions, nasal flaring, and prolonged expiration)
• Possible decreased air movement on auscultation
• A prolonged expiratory phase associated with increased expiratory effort (such as when expiration becomes an active rather than a passive process)
• Wheezing (most commonly expiratory but could also be inspiratory or biphasic)
• Coughing

In this next lesson on procainamide, we'll provide a Word on the other two types of respiratory distress and failure: lung tissue disease and disordered control of breathing.