Principle of oxygen therapy in the newborn
|
|
|
- Aleesha Strickland
- 7 years ago
- Views:
Transcription
1 Principle of oxygen therapy in the newborn Thrathip Kolatat M.D. Neonatal Intensive Care Unit Department of Pediatrics Faculty of Medicine Siriraj Hospital
2 Oxygen The most common drugs used in NICU Goal to achieve adequate delivery oxygen to tissues without creating oxygen toxicity
3 Oxygen The biomedical double-edged sword energy source of cellular life risk for oxygen toxicity There must be an oxygen pressure at which biological activity is optimal
4 Physiologic consideration External respiration transfer oxygen molecules from the atmosphere to blood Blood oxygen transport movement of oxygen from blood to the site of intracellular utilization Internal respiration oxygen consumption
5 External respiration definition: transfer oxygen molecules from atmosphere to the blood factors influence external respiration fraction of inspired oxygen distribution of ventilation alveolar gas exchange mixed venous-oxygen content
6 Unloading oxygen capabality (Term and Preterm) Term Preterm g.
7 Blood oxygen transport definition: movement of oxygen from the blood to the site of intracellular utilization factors influence blood oxygen transport cardiac output hemoglobin concentration hemoglobin oxygen affinity
8 Factors affected oxygen transport amount of oxygen in blood hemoglobin concentration partial pressure of oxygen oxygen-hemoglobin affinity delivery of oxygen blood pressure and blood volume cardiac output and distribution of flow viscosity abnormalities in cellular metabolism increased oxygen requirement e.g. hyperthermia, hypothermia
9 Hemoglobin-oxygen dissociation curve Shift to the left increased oxygen affinity less oxygen delivering to the tissue increased oxygen content Shift to the right decrease oxygen transport capability enhance movement of oxygen from blood to tissue decrease oxygen supply to tissue decrease oxygen content
10 Hemoglobin-oxygen dissociation curve
11 Blood oxygen transport oxygen content (OC) amount of hemoglobin hemoglobin-oxygen dissociation curve OC = oxy hemoglobin + dissolved oxygen Side chains Methyl, -CH 3 Vinyl, -CH-Ch 2 Proprionic acid,-ch 2 -CH 2 -COOH
12 Internal respiration definition: oxygen consumption factors influence internal respiration capillary perfusion diffusion of oxygen to tissue tissue oxygen utilization
13 Oxygen tension in cord blood and arterial blood at different postnatal age min mean max 20 0 UA UV 5-10min. 20min. 30min. 60min. 5hr. 24hr. 2days 3days 4days 5days 6days 7days
14 Method to delivery oxygen simple oxygen mask oxygen cannula oxygen hood oxygen box oxygen via incubator continuous positive airway pressure (CPAP)
15 Oxygen mask and cannula simple oxygen mask apply in an emergency situation provide a concentration of 50-90% recommended flow 3-6 LPM oxygen cannula provide a fixed concentration which vary on flow rate require a specific type of flow meter
16
17
18 Oxygen hood provide a stable concentration, visibility and access to most of the body recommend for acutely ill or unstable infants who require a FiO 2 > 0.40 a minimum flow rate of 3 LPM is recommended in order to prevent CO 2 retention
19 Oxygen box provide a stable concentration, visibility and access to most of the body recommend for a FiO 2 < 0.40 suitable for a chronically ill or stable infant in the crib
20 Oxygen via incubator provide a stable concentration, visibility and access to most of the body recommend for a FiO2 < 0.40 recommend for a stable infant in the incubator
21 Oxygen monitoring Oxygen analyzer Arterial PaO 2 VS Oxygen saturation
22 Oxygen monitoring PaO 2 transcutaneous oxygen monitoring (SpO 2 ) oxygen content PO mm Hg hemoglobin carries approx. 100 times more oxygen in plasma 2 components of oxygen load oxygen bound to hemoglobin (1g. of Hb binds 1.34 ml. oxygen) oxygen dissolved in plasma (0.3 ml O 2 /100 ml)
23 tissue oxygenation depends on PaO 2 or the saturation between tissue and blood in term of the saturation, change from fetal hemoglobin to adult hemoglobin should be considered in the newborn infants naturally occurred repeated transfusion during intensive care period Arterial PaO 2
24 Oxygen saturation limitation to detect hyperoxia (PaO 2 >12 kpa;spo 2 > 97%) sensitive to detect tissue hypoxemia when PaO 2 is at the critical level (PaO 2 is on the steep portion of the curve)
25 Oxygen saturation: limitation and recommendation no definite criteria for hypoxia to avoid hypoxia, saturation should be kept at the level of PaO 2 50 kpa saturation should be intermittently compared with PaO 2 obtained from ABG lower acceptable limit of saturation: 85% upper acceptable limit of saturation: 97%
26 advantages Oxygen saturation noninvasive rapid response time no tissue damage sensitive to detect hypoxia disadvantages varied with patient activity influenced by edema, phototherapy, perfusion insensitive to detect hyperoxia
27 Complications burns factors influence skin maturation tightness duration of probe attachment
28 Oxygen toxicity
29 Development of oxygen radical defense systems concentration of oxygen scavengers and antioxienzymes increase in lungs and kidney during pregnancy level of total antioxidant was lower in the preterm infants than the adult or term infants VLBW infants have a higher capacity to produce oxygen radicals by the respiratory burst than term infants
30 Oxygen free radical reperfusion injury accumulation of lipid peroxidation products following reperfusion protection by the administration of nonenzymatic antioxidants including vitamim E, glutathione, dimethylsulfoxide or enzymatic antioxidants the direct identification of free radicals by electron spin resonance spectroscopy
31 Actions of free radicals Role of hypoxanthine -xanthine oxidase system hypoxanthine is the end product of the purine catabolism in most human organs hypoxanthine is a break down product from ATP, AMP during hypoxia, hypoxanthine is accumulated when hypoxanthine is oxidized to uric acid, oxygen radicals are formed
32 Mechanism for ischemia/reperfusion injury ATP XD ischemia AMP protease hypoxanthine XO O 2 - O 2 + H 2 O 2 + urate oxygenation
33 Oxygen toxicity Neonatal free radical disease respiratory tract: bronchopulmonary dysplasia retina: retinopathy of prematurity brain: intraventricular hemorrhage, PV L gastrointestinal tract: necrotizing enterocolitis KUB: acute tubular necrosis
34 Oxygen free radicals + O H + 4 e O 2 + e O _ 2 O 2 + e H 2 O _ 2 H 2 O 2 + e.oh _.HO + e H 2 O 2 H 2 O (superoxide radical) (hydrogenperoxide) (hydroxyl radical) (water)
35 Chemical mechanism of oxygen toxicity Principle mechanism univalent reduction of molecular oxygen formation of free radical intermediates Reactive O 2 metabolites Superoxide free radical (O - 2 ) Hydrogen peroxide (H 2 O 2 ) Hydrogen free radical (OH - ) Singlet oxygen ( 1 O 2 )
36 Actions of free radicals injure biological membranes by lipid peroxidation inactivate enzyme denature proteins break double strand of DNA
37 Antioxidant enzyme defense system Superoxide dismutase (SOD) Catalase detoxified O - 2 detoxified H 2 O 2 Glutathione peroxidase (GP) detoxified H 2 O 2 G-6-PD provided NADPH reduced glutathione
38 Actions of free radicals Role of Iron nutritional iron deficiency in premature infants may be protective in oxygen radical-mediated injury lactoferrin and transferrin-like-iron-binding proteinpresent in breast milk may have protection from oxygen radical injury low serum level of apotransferrin and ceruloplasminin the premature infants may potentiate this type of injury
39 Actions of free radicals Role of the activated leukocyte on exposure to bacteria, the oxygen uptake of neutrophils is increased as much as 50-fold a large amount of superoxide and hydrogen peroxide radicals are formed leukocytes attack bacteria with oxygen radicals this phenomenon is called respiratory burst
40 Effects of alveolar macrophage Exposure to prolonged high inspired oxygen influx of polymorphonuclear leukocytes impaired antiprotease defense system release of proteolytic enzyme proteolytic damage in alveolar wall
41 Pulmonary change of oxygen toxicity atelectasis (surfactant inactivation) edema alveolar hemorrhage inflammation fibrin deposition thickening and hyalinization of alveolar membrane tracheal, bronchiolar and type 1 alveolar lining cells were damaged
42 Free radical scavengers and antioxidants Antioxidants vitamin E bilirubin
43 Free radical scavengers and antioxienzymes Free radical scavengers mannitols superoxide dismutase bilirubin uric acid dimethyl sulphoxide
44 Factors that determine oxygen toxicity maturation nutritional and endocrine status duration of expose to oxygen other oxidants A safe level of inspired oxygen has not been established, any concentration in excess of room air may increase the risk of lung damage when administered over a period of time
45 Policy for preventing ROP all infants who are at risk will be monitored with an oxygen saturation monitor the upper limits for the monitor alarm will be routinely set at 95% daily attempts should be made to lower the FiO2 in stable, convalescing infants with O2 saturations in the low to mid 90 s correlating arterial samples will be obtained/attempted attempted twice weekly
46 ROP: oxygen monitoring policy administer oxygen via a hood as a primary mode of delivery for infants < 1500 g use oximetry to determine the optimum flow and distance from the face when using short term blow by O2. monitor infants at risk by setting a strict upper limit for the oximeter of 95% If possible a calibration PaO2 should be obtained twice weekly; simultaneous FiO2, SaO2 and PaO2 will be recorded
47 ROP: oxygen monitoring policy obtain an arterial blood gas when an "at-risk" infant who was previously in room air is retreated with oxygen. if the arterial PaO2 > 90 mm Hg, notify a physician and document the response adjust FiO2 based on ordered parameters using oximetry and/or transcutaneous monitoring. ensure that an ROP check has been done at six weeks of age on infants <1500 g.
48 Prognostic factors P(A-a)O 2 difference in infants with PPHN, the mortality was 79% if P(A-a)O 2 was equal to 610 mm Hg for 8 consecutive hrs Oxygen index (OI) definition: MAP x FiO 2 / PaO 2 OI>40: 80% mortality OI>25: 50% mortality
49 Alveolar-arterial oxygen pressure difference determine ventilation/perfusion (V/Q) mismatch normal value for adult in RA: mm Hg normal value in the neonate mm Hg at birth 300 mmhg (FiO 2 1.0)
50 Alveolar-arterial Oxygen Pressure Difference P(A-a)O 2 alveolar-arterial oxygen pressure difference correlate with severity of lung disease method of calculation PAO 2 = [FiO 2 x (P atm - P H2 O )] - PCO 2 Exp. PaO 2 = 673 mm Hg (FiO 2 1.0; PCO 2 40 mmhg)
51 Etiology of high P(A-a)O 2 difference diffusion block at the alveolar-capillary level V/Q mismatch in the lung a result of ventilated areas poorly perfusion perfused areas poorly ventilated intracardiac fixed right-to-left shunt
52 Graph for estimation the shunt at different inspired oxygen %inspired oxygen 80%inspired oxygen 100%inspired oxygen
The Physiology of Hyperbaric Oxygen Therapy. Free Radicals and Reactive Oxygen Species. I. Introduction Definition, Source, function and Purpose
The Physiology of Hyperbaric Oxygen Therapy Free Radicals and Reactive Oxygen Species I. Introduction Definition, Source, function and Purpose A. Definition of free radicals and reactive oxygen species
MECHINICAL VENTILATION S. Kache, MD
MECHINICAL VENTILATION S. Kache, MD Spontaneous respiration vs. Mechanical ventilation Natural spontaneous ventilation occurs when the respiratory muscles, diaphragm and intercostal muscles pull on the
Why is prematurity a concern?
Prematurity What is prematurity? A baby born before 37 weeks of pregnancy is considered premature. Approximately 12% of all babies are born prematurely. Terms that refer to premature babies are preterm
Oxygenation and Oxygen Therapy Michael Billow, D.O.
Oxygenation and Oxygen Therapy Michael Billow, D.O. The delivery of oxygen to all body tissues is the essence of critical care. Patients in respiratory distress/failure come easily to mind as the ones
More detailed background information and references can be found at the end of this guideline
Neonatal Intensive Care Unit Clinical Guideline Oxygen Over the past few years there have been significant changes, based on high quality research, in our understanding of how to give the right amount
NHS FORTH VALLEY Neonatal Oxygen Saturation Guideline
NHS FORTH VALLEY Neonatal Oxygen Saturation Guideline Date of First Issue 11/07/2011 Approved 30/09/2011 Current Issue Date 07/09/2011 Review Date July 2013 Version 1 EQIA Yes 22/10/2011 Author / Contact
PULMONARY PHYSIOLOGY
I. Lung volumes PULMONARY PHYSIOLOGY American College of Surgeons SCC Review Course Christopher P. Michetti, MD, FACS and Forrest O. Moore, MD, FACS A. Tidal volume (TV) is the volume of air entering and
Determinants of Blood Oxygen Content Instructor s Guide
Determinants of Blood Oxygen Content Instructor s Guide Time to Complete This activity will take approximately 75 minutes, but can be shortened depending on how much time the instructor takes to review
Oxygenation. Chapter 21. Anatomy and Physiology of Breathing. Anatomy and Physiology of Breathing*
Oxygenation Chapter 21 Anatomy and Physiology of Breathing Inspiration ~ breathing in Expiration ~ breathing out Ventilation ~ Movement of air in & out of the lungs Respiration ~ exchange of O2 & carbon
TRANSPORT OF BLOOD GASES From The Lungs To The Tissues & Back
TRANSPORT OF BLOOD GASES From The Lungs To The Tissues & Back Dr. Sally Osborne Department of Cellular & Physiological Sciences University of British Columbia Room 3602, D.H Copp Building 604 822-3421
Ventilation Perfusion Relationships
Ventilation Perfusion Relationships VENTILATION PERFUSION RATIO Ideally, each alveolus in the lungs would receive the same amount of ventilation and pulmonary capillary blood flow (perfusion). In reality,
Pulmonary Diseases. Lung Disease: Pathophysiology, Medical and Exercise Programming. Overview of Pathophysiology
Lung Disease: Pathophysiology, Medical and Exercise Programming Overview of Pathophysiology Ventilatory Impairments Increased airway resistance Reduced compliance Increased work of breathing Ventilatory
Cell Injury, Adaptation and Death
Harvard-MIT Division of Health Sciences and Technology HST.035: Principle and Practice of Human Pathology Dr. Badizadegan Cell Injury, Adaptation and Death HST.035 Spring 2003 Overview of Cell Injury Cells
Respiratory failure and Oxygen Therapy
Respiratory failure and Oxygen Therapy A patient with Hb 15 G % will carry 3X more O2 in his blood than someone with Hb 5G % Give Controlled O2 treatment in acute pulmonary oedema to avoid CO2 retention
Extracorporeal Life Support Organization (ELSO) Guidelines for Neonatal Respiratory Failure
Extracorporeal Life Support Organization (ELSO) Guidelines for Neonatal Respiratory Failure Introduction This neonatal respiratory failure guideline is a supplement to ELSO s General Guidelines for all
Hyperbaric Oxygen Therapy WWW.RN.ORG
Hyperbaric Oxygen Therapy WWW.RN.ORG Reviewed September, 2015, Expires September, 2017 Provider Information and Specifics available on our Website Unauthorized Distribution Prohibited 2015 RN.ORG, S.A.,
Antioxidant Products. A comprehensive range of. Antioxidants
Antioxidant Products A comprehensive range of ALB BIL FERR GR Ransel Ransod antioxidant TAS testing TIBC kits TF BIL FERR GR Ransel Ransod TAS TIBC TF UA A FERR GR Ransel Ransod TAS TIBC TF UA ALB GR Ransel
GUIDELINES FOR HOSPITALS WITH NEONATAL INTENSIVE CARE SERVICE : REGULATION 4 OF THE PRIVATE HOSPITALS AND MEDICAL CLINICS REGULATIONS [CAP 248, Rg 1] I Introduction 1. These Guidelines serve as a guide
Accuracy and reliability of pulse oximetry in
Accuracy and reliability of pulse oximetry in premature neonates with respiratory distress GINNY W. HENDERSON, CRNA, MS Concordville, Pennsylvania Continuous noninvasive monitoring of oxygenation in premature
Oxygen Dissociation Curve
122 Visit http://www.anaesthesiamcq.com for details Chapter 4 Dissociation Curve Can you draw the oxygen dissociation curve of normal adult haemoglobin? How many points on the curve can you indicate with
5/30/2014 OBJECTIVES THE ROLE OF A RESPIRATORY THERAPIST IN THE DELIVERY ROOM. Disclosure
THE ROLE OF A RESPIRATORY THERAPIST IN THE DELIVERY ROOM Ona Fofah, MD FAAP Assistant Professor of Pediatrics Director, Division of Neonatology Department of Pediatrics Rutgers- NJMS, Newark OBJECTIVES
ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) S. Agarwal, MD, S. Kache MD
ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) S. Agarwal, MD, S. Kache MD Definition ARDS is a clinical syndrome of lung injury with hypoxic respiratory failure caused by intense pulmonary inflammation that
Gas Exchange. Graphics are used with permission of: Pearson Education Inc., publishing as Benjamin Cummings (http://www.aw-bc.com)
Gas Exchange Graphics are used with permission of: Pearson Education Inc., publishing as Benjamin Cummings (http://www.aw-bc.com) Page 1. Introduction Oxygen and carbon dioxide diffuse between the alveoli
Arterial Blood Gas Case Questions and Answers
Arterial Blood Gas Case Questions and Answers In the space that follows you will find a series of cases that include arterial blood gases. Each case is then followed by an explanation of the acid-base
NICU Level of Care Criteria
Introduction The NICU Criteria were developed to assist in the authorization for various levels of Neonatal Intensive Care Unit (NICU), as well as assistance in determining the appropriate level of care.
Pathophysiology of hypercapnic and hypoxic respiratory failure and V/Q relationships. Dr.Alok Nath Department of Pulmonary Medicine PGIMER Chandigarh
Pathophysiology of hypercapnic and hypoxic respiratory failure and V/Q relationships Dr.Alok Nath Department of Pulmonary Medicine PGIMER Chandigarh Jan 2006 Respiratory Failure inadequate blood oxygenation
Gas Exchange Graphics are used with permission of: adam.com (http://www.adam.com/) Benjamin Cummings Publishing Co (http://www.awl.
Gas Exchange Graphics are used with permission of: adam.com (http://www.adam.com/) Benjamin Cummings Publishing Co (http://www.awl.com/bc) Page 1. Introduction Oxygen and carbon dioxide diffuse between
What, roughly, is the dividing line between the upper and lower respiratory tract? The larynx. What s the difference between the conducting zone and
What, roughly, is the dividing line between the upper and lower respiratory tract? The larynx. What s the difference between the conducting zone and the respiratory zone? Conducting zone is passageways
William Shaw, Ph.D. The Great Plains Laboratory, Inc., Lenexa, Kansas, USA
Inhibition of dopamine conversion to norepinephrine by Clostridia metabolites appears to be a (the) major cause of autism, schizophrenia, and other neuropsychiatric disorders. All these factors can now
What to Know About HBO (Hyperbaric Oxygen Therapy)
Objectives What to Know About HBO (Hyperbaric Oxygen Therapy) Presented by Catherine Rogers, APN, BC, CWCN, CWS, FACCWS Advanced Practice Nurse/Program Manager SwedishAmerican Health System Rockford, IL
Brain Injury during Fetal-Neonatal Transition
Brain Injury during Fetal-Neonatal Transition Adre du Plessis, MBChB Fetal and Transitional Medicine Children s National Medical Center Washington, DC Brain injury during fetal-neonatal transition Injury
Ischemia and Infarction
Harvard-MIT Division of Health Sciences and Technology HST.035: Principle and Practice of Human Pathology Dr. Badizadegan Ischemia and Infarction HST.035 Spring 2003 In the US: ~50% of deaths are due to
Understanding Hypoventilation and Its Treatment by Susan Agrawal
www.complexchild.com Understanding Hypoventilation and Its Treatment by Susan Agrawal Most of us have a general understanding of what the term hyperventilation means, since hyperventilation, also called
From AARC Protocol Committee; Subcommittee Adult Critical Care Version 1.0a (Sept., 2003), Subcommittee Chair, Susan P. Pilbeam
AARC - ADULT MECHANICAL VENTILATOR PROTOCOLS 1. Guidelines for Using Ventilator Protocols 2. Definition of Modes and Suggestions for Use of Modes 3. Adult Respiratory Ventilator Protocol - Guidelines for
Absorption of Drugs. Transport of a drug from the GI tract
Absorption of Drugs Absorption is the transfer of a drug from its site of administration to the bloodstream. The rate and efficiency of absorption depend on the route of administration. For IV delivery,
The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy
The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy Cindy Goodrich RN, MS, CCRN Content Description Sepsis is caused by widespread tissue injury and systemic inflammation resulting
TRANSPORT OF OXYGEN AND CARBON DIOXIDE IN BLOOD
TRANSPORT OF OXYGEN AND CARBON DIOXIDE IN BLOOD CONTENTS INTRODUCTION OXYGEN CASCADE OXYGEN DELIVERY DURING EXERCISE OXYGEN DELIVERY DURING CRITICAL ILLNESS CARBON DIOXIDE TRANSPORT O2 TRANSPORT REQUIREMENTS
21.8 The Citric Acid Cycle
21.8 The Citric Acid Cycle The carbon atoms from the first two stages of catabolism are carried into the third stage as acetyl groups bonded to coenzyme A. Like the phosphoryl groups in ATP molecules,
Pulmonary interstitium. Interstitial Lung Disease. Interstitial lung disease. Interstitial lung disease. Causes.
Pulmonary interstitium Interstitial Lung Disease Alveolar lining cells (types 1 and 2) Thin elastin-rich connective component containing capillary blood vessels Interstitial lung disease Increase in interstitial
Oxygen Therapy. Oxygen therapy quick guide V3 July 2012.
PRESENTATION Oxygen (O 2 ) is a gas provided in a compressed form in a cylinder. It is also available in a liquid form. It is fed via a regulator and flow meter to the patient by means of plastic tubing
Rules on Oxygen Therapy:
Rules on Oxygen Therapy: Physiology: 1. PO 2, SaO 2, CaO 2 are all related but different. 2. PaO2 is a sensitive and non-specific indicator of the lungs ability to exchange gases with the atmosphere. 3.
240- PROBLEM SET INSERTION OF SWAN-GANZ SYSTEMIC VASCULAR RESISTANCE. Blood pressure = f(cardiac output and peripheral resistance)
240- PROBLEM SET INSERTION OF SWAN-GANZ 50 kg Pig Rt Jugular 0 cm Rt Atrium 10 cm Rt ventricle 15 cm Wedge 20-25 cm SYSTEMIC VASCULAR RESISTANCE Blood pressure = f(cardiac output and peripheral resistance)
Hyperbaric Oxygen Therapy & Oxygen Toxicity. Module III. CRC 431 Special Procedures
& Oxygen Toxicity Module III CRC 431 Special Procedures HBO OUTLINE Definitions History Altitude/descent Gas laws Physiologic effects of HBO Therapeutic oxygen at pressures greater than 1 atm Unit expressing
Clinical Indications for Hyperbaric Oxygen Therapy in 2011 Part 1
Clinical Indications for Hyperbaric Oxygen Therapy in 2011 Part 1 Med LtCol Peter GERMONPRE Centre for Hyperbaric Oxygen Therapy Military Hospital Brussels What is HBO therapy? Breathing oxygen under pressure
Premature Infant Care
Premature Infant Care Introduction A premature baby is born before the 37th week of pregnancy. Premature babies are also called preemies. Premature babies may have health problems because their organs
Inflammation and Healing. Review of Normal Defenses. Review of Normal Capillary Exchange. BIO 375 Pathophysiology
Inflammation and Healing BIO 375 Pathophysiology Review of Normal Defenses Review of Normal Capillary Exchange 1 Inflammation Inflammation is a biochemical and cellular process that occurs in vascularized
Pediatric Airway Management
Pediatric Airway Management Dec 2003 Dr. Shapiro I., PICU Adult Chain of Survival EMS CPR ALS Early Defibrillation Pediatric Chain of Survival Prevention CPR EMS ALS Out-of-Hospital Cardiac Arrest SIDS
Oxygen - update April 2009 OXG
PRESENTATION Oxygen (O 2 ) is a gas provided in compressed form in a cylinder. It is also available in liquid form, in a system adapted for ambulance use. It is fed via a regulator and flow meter to the
Safe Zone: CV PIP < 26; HFOV: MAP < 16; HFJV: MAP < 16 Dopamine infusion up to 20 mcg/kg/min Epinephrine infusion up to 0.1 mcg /kg/min.
Congenital Diaphragmatic Hernia: Management Guidelines 5-2006 Issued By: Division of Neonatology Reviewed: Effective Date: Categories: Chronicity Document Congenital Diaphragmatic Hernia: Management Guidelines
CPT Pediatric Coding Updates 2009. The 2009 Current Procedural Terminology (CPT) codes are effective as of January 1, 2009.
CPT Pediatric Coding Updates 2009 The 2009 Current Procedural Terminology (CPT) codes are effective as of January 1, 2009. NEW CODES Evaluation and Management Services Normal Newborn Care Codes 99431-99440
ACID- BASE and ELECTROLYTE BALANCE. MGHS School of EMT-Paramedic Program 2011
ACID- BASE and ELECTROLYTE BALANCE MGHS School of EMT-Paramedic Program 2011 ACID- BASE BALANCE Ions balance themselves like a see-saw. Solutions turn into acids when concentration of hydrogen ions rises
IMPAIRED BLOOD-GAS EXCHANGE. Intraoperative blood gas analysis
IMPAIRED BLOOD-GAS EXCHANGE Intraoperative blood gas analysis When do you perform BGA Intraoperatively? Informe actual NEVER Routine:Thoracic Thoracic, Cardiac,Neurosurgery Emergency situation Drop in
Acid/Base and ABG Interpretation Made Simple
Acid/Base and ABG Interpretation Made Simple A-a a Gradient FIO2 = PA O2 + (5/4) PaCO2 FIO2 = 713 x O2% A-a a gradient = PA O2 - PaO2 Normal is 0-100 mm Hg 2.5 + 0.21 x age in years With higher inspired
6 Easy Steps to ABG Analysis
6 Easy Steps to ABG Analysis E-Booklet David W. Woodruff, MSN, RN- BC, CNS, CMSRN, CEN 571 Ledge Road, Macedonia, OH 44056 Telephone (800) 990-2629 Fax (800) 990-2585 1997-2012 Ed4Nurses, Inc. All rights
Hypoxia and Oxygenation Hypoxia is a serious threat to patients and escorts alike when
Chapter 4 2 71 Hypoxia and Oxygenation Hypoxia is a serious threat to patients and escorts alike when they fly. Air medical escorts need to understand what causes hypoxia, why some people are more likely
1. The diagram below represents a biological process
1. The diagram below represents a biological process 5. The chart below indicates the elements contained in four different molecules and the number of atoms of each element in those molecules. Which set
Oxygen Transport Calculations M. L. Cheatham, MD, FACS, FCCM
OXYGEN TRANSPORT CALCULATIONS Supply Demand Michael L. Cheatham, MD, FACS, FCCM Director, Surgical Intensive Care Units Orlando Regional Medical Center Orlando, Florida IN REVIEW There are four primary
OXYGEN THERAPY. DR :Gehan Ali. Lecturer of chest Ds Menoufia university
OXYGEN THERAPY DR :Gehan Ali Lecturer of chest Ds Menoufia university O 2 Therapy : Indications Documented hypoxemia as evidenced by PaO 2 < 60 mmhg or SaO 2 < 90% on room air PaO 2 or SaO 2 below desirable
Pharmacology of the Respiratory Tract: COPD and Steroids
Pharmacology of the Respiratory Tract: COPD and Steroids Dr. Tillie-Louise Hackett Department of Anesthesiology, Pharmacology and Therapeutics University of British Columbia Associate Head, Centre of Heart
UNIT 3 : MAINTAINING DYNAMIC EQUILIBRIUM
BIOLOGY - 2201 UNIT 3 : MAINTAINING DYNAMIC EQUILIBRIUM What happens to your body as you run? Breathing, heart rate, temperature, muscle pain, thirsty... Homeotasis Homeostasis is the process of maintaining
Delayed Cord Clamping
ICEA Position Paper Delayed Cord Clamping Position The International Childbirth Education Association recognizes that the first minutes after birth are crucial to both mother and newborn. Optimal care
Ann.wellhouse@TouchStoneScience.net 1. Enzyme Function
Ann.wellhouse@TouchStoneScience.net 1 Enzyme Function National Science Standards Science as Inquiry: Content Standard A: As a result of activities in grades 9-12, all students should develop: Abilities
Evaluation copy. Figure 1
O 2 Extraction by the Lungs Computer 23 Oxygen is required for cell metabolism. During inhalation air is brought into the lungs, where oxygen is extracted. Oxygen passes into the bloodstream at the membrane
MEDCHEM 562 Fall 2013 Vitamin Problem Set 1: Deficiency
1) Complete the table: MEDCHEM 562 Fall 2013 Vitamin Problem Set 1: Vitamin Function / Uses Deficiency States Toxicities Daily Value Upper Limit A D E K 2) Complete the metabolic pathway shown below: Retinyl
Chapter 26. Assisting With Oxygen Needs. Elsevier items and derived items 2014, 2010 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Chapter 26 Assisting With Oxygen Needs Oxygen (O 2 ) is a gas. Oxygen It has no taste, odor, or color. It is a basic need required for life. Death occurs within minutes if breathing stops. Brain damage
UNDERSTANDING CONTINUOUS MIXED VENOUS OXYGEN SATURATION (SvO 2 ) MONITORING WITH THE SWAN-GANZ OXIMETRY TD SYSTEM
UNDERSTANDING CONTINUOUS MIXED VENOUS OXYGEN SATURATION (SvO 2 ) MONITORING WITH THE SWAN-GANZ OXIMETRY TD SYSTEM UNDERSTANDING CONTINUOUS MIXED VENOUS OXYGEN SATURATION (SvO2) MONITORING WITH THE EDWARDS
Common Conditions, Concerns, and Equipment in the NICU
Common Conditions, Concerns, and Equipment in the NICU Babies in the NICU are carefully monitored because of their health risk. While the following is a comprehensive list of common conditions found in
RESPIRATORY VENTILATION Page 1
Page 1 VENTILATION PARAMETERS A. Lung Volumes 1. Basic volumes: elements a. Tidal Volume (V T, TV): volume of gas exchanged each breath; can change as ventilation pattern changes b. Inspiratory Reserve
Lothian Guideline for Domiciliary Oxygen Therapy Service for COPD
Lothian Guideline for Domiciliary Oxygen Therapy Service for COPD This document describes the standard for clinical assessment, prescription, optimal management and follow-up of patients receiving domiciliary
Introduction to Cardiopulmonary Exercise Testing
Introduction to Cardiopulmonary Exercise Testing 2 nd Edition Andrew M. Luks, MD Robb Glenny, MD H. Thomas Robertson, MD Division of Pulmonary and Critical Care Medicine University of Washington Section
The Initial and 24 h (After the Patient Rehabilitation) Deficit of Arterial Blood Gases as Predictors of Patients Outcome
Biomedical & Pharmacology Journal Vol. 6(2), 259-264 (2013) The Initial and 24 h (After the Patient Rehabilitation) Deficit of Arterial Blood Gases as Predictors of Patients Outcome Vadod Norouzi 1, Ali
Laboratory Monitoring of Adult Hospital Patients Receiving Parenteral Nutrition
Laboratory Monitoring of Adult Hospital Patients Receiving Parenteral Nutrition Copy 1 Location of copies Web based only The following guideline is for use by medical staff caring for the patient and members
Nursing 113. Pharmacology Principles
Nursing 113 Pharmacology Principles 1. The study of how drugs enter the body, reach the site of action, and are removed from the body is called a. pharmacotherapeutics b. pharmacology c. pharmacodynamics
Common Ventilator Management Issues
Common Ventilator Management Issues William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center You have just admitted a 28 year-old
A. All cells need oxygen and release carbon dioxide why?
I. Introduction: Describe how the cardiovascular and respiratory systems interact to supply O 2 and eliminate CO 2. A. All cells need oxygen and release carbon dioxide why? B. Two systems that help to
Influenza (Flu) Influenza is a viral infection that may affect both the upper and lower respiratory tracts. There are three types of flu virus:
Respiratory Disorders Bio 375 Pathophysiology General Manifestations of Respiratory Disease Sneezing is a reflex response to irritation in the upper respiratory tract and is associated with inflammation
James F. Kravec, M.D., F.A.C.P
James F. Kravec, M.D., F.A.C.P Chairman, Department of Internal Medicine, St. Elizabeth Health Center Chair, General Internal Medicine, Northeast Ohio Medical University Associate Medical Director, Hospice
Hydroxyurea Treatment for Sickle Cell Disease
Hydroxyurea Treatment for Sickle Cell Disease Before hydroxyurea After hydroxyurea Hydroxyurea Treatment for Sickle Cell Disease 1 This document is not intended to take the place of the care and attention
Airway Pressure Release Ventilation
Page: 1 Policy #: 25.01.153 Issued: 4-1-2006 Reviewed/ Revised: Section: 10-11-2006 Respiratory Care Airway Pressure Release Ventilation Description/Definition Airway Pressure Release Ventilation (APRV)
Altitude. Thermoregulation & Extreme Environments. The Stress of Altitude. Reduced PO 2. O 2 Transport Cascade. Oxygen loading at altitude:
Altitude Thermoregulation & Extreme Environments Reduced PO 2 The Stress of Altitude O 2 Transport Cascade Progressive change in environments oxygen pressure & various body areas Oxygen loading at altitude:
Using a Reservoir Nasal Cannula in Acute Care
Using a Reservoir Nasal Cannula in Acute Care Cheryl Plate Dumont, RN, MSN, CCRN Brian L. Tiep, MD Oxymizer and Oxym i z e r Pendant (CHAD Therapeutics Inc, Chatsworth, Calif) brand reservoir cannulas
Milliman Guidelines NICU Levels*
Milliman Guidelines NICU Levels* Neonatal Intensive Care Unit Level IV If the following conditions/procedures exist, in addition to the fulfillment of Level III Criteria, the approved inpatient days should
Newborn Screening Update for Health Care Practitioners
Newborn Screening Update for Health Care Practitioners Changes in regulations affecting your practice for newborns transferred to neonatal intensive care units. Changes for newborn screening of premature,
Pulse Oximetry and the Oxyhemoglobin Dissociation Curve
Pulse Oximetry and the Oxyhemoglobin Dissociation Curve by: SSB Healthcare Division Course Outline I. Course Objectives II. Introduction III. History IV. Pulse Oximeter Definition A. What is it? B. What
Medicaid Disability Manual
Part B The following sections apply to individuals under age 18. If the criteria in Part B do not apply, Part A criteria may be used when those criteria give appropriate consideration to the effects of
Biochemistry 462a Hemoglobin Structure and Function Reading - Chapter 7 Practice problems - Chapter 7: 1-6; Proteins extra problems
Biochemistry 462a Hemoglobin Structure and Function Reading - Chapter 7 Practice problems - Chapter 7: 1-6; Proteins extra problems Myoglobin and Hemoglobin Oxygen is required for oxidative metabolism
Cord Blood Erythropoietin and Markers of Fetal Hypoxia
July 21, 2011 By NeedsFixing [1] To investigating the relationship between cord blood erythropoietin and clinical markers of fetal hypoxia. Abstract Objective: To investigating the relationship between
Acid-Base Balance and the Anion Gap
Acid-Base Balance and the Anion Gap 1. The body strives for electrical neutrality. a. Cations = Anions b. One of the cations is very special, H +, and its concentration is monitored and regulated very
Medicare C/D Medical Coverage Policy
Medicare C/D Medical Coverage Policy Oxygen and Oxygen Supplements Origination: April 10, 1992 Review Date: July 15, 2015 Next Review: July, 2017 DESCRIPTION OF PROCEDURE OR SERVICE USP Oxygen is a gaseous
Is Exercise the Best Antioxidant Supplement? Len Kravitz, Ph.D.
Is Exercise the Best Antioxidant Supplement? Len Kravitz, Ph.D. As an unexpected consequence of the metabolic steps that convert food into energy, the body produces molecules commonly called free radicals.
SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY
PS1006 SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY TITLE: NEONATAL INTENSIVE CARE UNIT: ADMISSION AND TRANSFER PROCEDURE AND ACUITY GUIDELINES Job Title of Reviewer: EFFECTIVE DATE: REVISED DATE:
Fetal Responses to Reduced Oxygen Delivery
Fetal Responses to Reduced Oxygen Delivery Abraham M Rudolph Fetal Cardiology Symposium May 2016, Phoenix Faculty Disclosure Information I have no financial relationship with any manufacturer of any commercial
Recommendations: Other Supportive Therapy of Severe Sepsis*
Recommendations: Other Supportive Therapy of Severe Sepsis* K. Blood Product Administration 1. Once tissue hypoperfusion has resolved and in the absence of extenuating circumstances, such as myocardial
Chapter 16: Circulation
Section 1 (The Body s Transport System) Chapter 16: Circulation 7 th Grade Cardiovascular system (the circulatory system) includes the heart, blood vessels, and blood carries needed substances to the cells
POLICIES & PROCEDURES. ID Number: 1115
POLICIES & PROCEDURES Title: OXYGEN ADMINISTRATION ID Number: 1115 Authorization [X] SHR Nursing Practice Committee Source: Nursing, Respiratory Therapy, Physiotherapy Date Revised: March 2015 Date of
Hummi Micro Draw Blood Transfer Device. The Next Generation System for Closed Micro Blood Sampling in the Neonate
Hummi Micro Draw Blood Transfer Device The Next Generation System for Closed Micro Blood Sampling in the Neonate Current Methods for Umbilical Blood Sampling Current Methods for Umbilical Blood Sampling
Chemistry. All the three compounds are Naphthoquinone derivatives
VITAMIN K History Existence first suggested by Henrik Dam in 1929 - Observed : Hemorrhagic disease of cattle fed on synthetic diets 1939 : Dam & co-workers isolated Vitamin K from the plant Alfalfa Edward
Overall Goals/Objectives - Surgical Critical Care Residency Program The goal of the Pediatric Surgical Critical Care Residency program is to provide
Overall Goals/Objectives - Surgical Critical Care Residency Program The goal of the Pediatric Surgical Critical Care Residency program is to provide advanced proficiency in the care and management of critically
The Advantages of Transcutaneous Co 2 Over End-Tidal Co 2 for Sleep Studies PETCo 2 vs. TCPCo 2
The Advantages of Transcutaneous Co 2 Over End-Tidal Co 2 for Sleep Studies PETCo 2 vs. TCPCo 2 Ramalinga P. Reddy, M.D., MBA, FCCP Director, Children s Pulmonary & Sleep Center Mercy Children s Hospital
CRITICAL CARE MONITORING: WHAT, WHEN, AND HOW? Susan G. Hackner, BVSc.MRCVS.DACVIM.DACVECC.
CRITICAL CARE MONITORING: WHAT, WHEN, AND HOW? Susan G. Hackner, BVSc.MRCVS.DACVIM.DACVECC. A crucial goal in the critical patient is the maintenance and optimization of cellular (and organ) health. Cellular