Oxygen Therapy -----------------------------------
Oxygen is a substance which is very important in the lives of humans and other living creatures. Oxygen is required for normal breathing oganisme aerobics. Oxygen is 50% components of the planet earth, 21% component of the air we breathe, and 89% water component.
The aim is to overcome the oxygen therapy that tissue hypoxia occurs due to decreased arterial oxygen pressure. Patients rarely survive with arterial oxygen pressure values in the red region (pressure £ 25 mmHg).
Giving Oxygen Method
1. Variable performance
These uncontrolled administer oxygen therapy devices, Because the patient creates the inspired mixture by the act of breathing. Example: a nasal catheter, nasal cannula, mask shells with or without rebreathing bag.
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Shell masks low capacity
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Nasal cannula
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High capacity systems
(Non re-breathing mask)
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Nasal catheter
1. Fixed performances
These devices allow a controlled oxygen dosage. They create a constant proportion of water / oxygen mixture in excess of patient inspiratory flow rate and are independent of patient factors or the fit to the face. With gas flow constantly in excess of patient demand and with enhanced CO2 washout, rebreathing is virtually eliminated.
Venturi Mask Ventimask
Road Management Concepts ------------------------- Breath
Anatomy
Relations airway and the outside world got through two avenues:
1. À nose into the nasopharynx
2. Mouth à toward orofaring
Nose and mouth at the front separated by the palate palate durum and molle; in the rear united in hipofaring. Hipofaring toward the esophagus and larynx are separated by epiglotis toward the trachea. Larynx consists of the thyroid cartilage, krikoid, epiglotis, and a pair aritenoid, kornikulata and kuneiform.
Innervation
1. N. trigeminal (V), mensarafi nasal mucosa, palate (V-1), the maxillary (V-2), tongue and mandibular regions (V-3).
2. N. facial (seventh), mensarafi palate.
3. N. glossofaringeus (IX), mensarafi tongue, pharynx, palate and tonsils mole.
4. N. vagus (X), mensarafi epiglotis and the area around the vocal cords.
Airway obstruction
In the unconscious patient or in a state teranestesi supine position, muscle tone upper airway and genioglossus muscle is lost; so that the tongue will clog hipofaring and cause airway obstruction either total or partial. This situation often occurs and must be quickly found and corrected in several ways such as triple airway maneuvers (triple airway manuever), installation of equipment pharyngeal airway (pharyngeal airway), the installation of the appliance lid laryngeal airway (laryngeal mask airway), installation of pipe trachea ( endotracheal tube). Obstruction can also be caused by spasm of the larynx during light anesthesia and a painful stimulus or stimuli by secretions.
Signs of Airway Obstruction
1. Stridor
2. Nostril breath
3. Retracted trachea
4. Chest wall retraction
5. There was no expiratory air
Larynx spasms, or cramps
Occur because the vocal cords close partially or completely. This condition is usually caused by a mild anesthesia or in people who received stimulation of the pharynx.
Treatment:
1. Triple airway maneuver
2. Positive ventilation with oxygen 100%
Triple ----------------------------- airway maneuvers
Triple airway maneuvers consist of:
1. Head extension of a joint atlanto-occipital muscle
2. Mandible pushed forward on the second mandibular angle
3. Mouth opened
With this maneuver is expected to lift the tongue and airway free, so that gas or air smoothly into the trachea through the nose or mouth.
Step 2
Step 3
------------------- Various Kinds of breath Road Management Tool
Airway pharynx
If less successful triple maneuver, it can be fitted mouth-pharynx airway through the mouth (OPA, oro-pharyngeal airway) or nasal-pharyngeal airway through the nose (NPA, naso-pharyngeal aiway).
NPA: shaped like a round hole in the middle of the pipe is made of soft latex rubber. Installation must be careful to avoid the trauma and nasal mucosa, tube smeared with jelly.
OPA: Shaped pipe flattened curved like the letter C with a hole in the middle with one end wall stemmed with greater efforts to prevent interference with the hole when the patient bite patency; so that air flow remains assured.
OPA is also fitted with a pipe, or lid lring trachea to maintain patency of both the appliance bite patients.
Front lid
Lid face (face mask) led the air / gas from the anesthesia resuscitation equipment or systems of anesthesia to a patient airway. The shape is made such that when used for spontaneous breathing or with positive pressure and the gas leak did not enter all of the trachea through the mouth or nose. Lid shape varies depending on age face the patient and the manufacturer. Size 03 for a newborn; 02, 01, one for small children; 2, 3 for big kids, and 4, 5 to adult. Some uncovered face of a transparent material so that expiratory air look (sweating) or if there's vomit or lips looked pinched.
Larynx lid
Sungkup larynx (LMA, laryngeal mask airway) is a spoon-shaped tool airway consists of a large pipe perforated with the tip of the spoon that resembles dikembangkempiskan edges can be like a balloon on the pipe trachea. Pipestem LMA can be a hard pipe of polyvinyl or softening with a spiral to keep the hole remained patent.
Known two kinds of caps larynx:
1. Standard laryngeal lid with a breathing tube.
2. Laryngeal lid with two pipes: one standard and other breathing tube additional pipe connected with the distal end of the esophagus.
Face mask
Laryngeal mask airway (LMA)
LMA size and its allocation
Age Size Weight (kg)
1.0 Neonates <3
1.3 Infant 30-10
2.0 Small children 10-20
2.3 Child 20-30
3.0 Small Adults 30-40
4.0 Normal Adults 40-60
Adult large 5.0> 60
LMA installation mode can be done with or without the help laringoskop. Actually this tool is made for the purpose, among others, that can be mounted directly without the help of tools and can be used when the trachea intubation is forecast to experience difficulties. LMA was not able to replace the trachea intubation, but it lies between the front lid and trachea intubation.
Installation should be deep enough to wait anesthesia or paralytic muscles used to avoid the trauma of the oral cavity, pharynx, larynx. After the appliance is installed, to avoid being bitten his breathing tube, it can be mounted gauze rolls (bite block) or the oral pharyngeal breathing tube (OPA).
Pipe trachea
Pipe trachea (endotracheal tube) to take the gas anesthetic directly into the trachea and are usually made from polyvinyl chloride standard materials. Diameter hole in the pipe is expressed in millimeters. Because the trachea cross-section babies, children and adults are different - trachea cross-section babies and small children under the age of five years is almost spherical, while mature shaped like the letter D - is for babies and small children used without the cuff, whereas for big kids and adults with cuff so as not to leak.
Use cuff in infants and young children can create trachea mucous membrane trauma. If we want to use the pipe trachea with the cuff on the infant, we must use a trachea tube diameter size smaller and this makes the risk of airway resistance is greater. Pipe trachea can be inserted through the mouth (orotrakheal tube) or through the nose (nasotracheal tube). On the free market known several sizes and estimates the size required can be seen in the table below.
Pipe trachea and its allocation
Age Diameter (mm) Distance French Scale up lips (cm)
Premature 2.0 - 2.5 10 10
Neonates 2.5 - 3.5 12 11
1-6 months 3.0 - 4.0 14 11
½ - 1 year 3.5 - 4.0 16 12
1-4 years 4.0 - 5.0 18 13
4-6 years 4.5 - 5.5 20th 14th
6-8 year 5.0 - 5.5 22 15-16
80-10 years 5.5 - 6.0 24th 16-17
10 -12 years 6.0 - 6.5 26 17-18
12-14 years 6.5 - 7.0 28-30 18-22
Adult female 6.5 - 8.5 28-30 20-24
Adult male 05.07 - 10.0 32-34 20-24
How to choose a trachea tube for infants and young children:
The diameter of the pipe trachea (mm) = 4.0 + ¼ age (years)
Oro-trakheal pipe length (cm) = 12 + ½ age (years)
Naso-trakheal pipe length (cm) = 12 + ½ age (years)
Laryngoscopy and Intubation
Laryngeal function was to prevent foreign matter into the lungs. Laringoskop is a tool used to view the larynx directly so that we can enter the trachea tube well and correctly. Broadly speaking there are two kinds laringoskop:
1. Blades, leaf (blade), straight (Macintosh) for babies - children - adult
2. Curved blades (Miller, Magill) for big kids - adult
Difficulties associated with the trachea tube insert anatomical variations encountered.
laryngoscope
Intubation
Intubation trachea Indication
Intubation trachea trachea tube is put into action in the trachea via rima glottis, so that distal end located approximately in the middle trachea between the vocal cords, and trachea bifurcation. Indications vary and are generally classified as follows:
1. Maintain airway patency by any cause
Anatomical abnormalities, especially surgical, surgical special position, clearing the airway secretions, and others.
1. Facilitate positive ventilation and oxygenation
For example during resuscitation, allowing the use of relaxants with efficient, long-term ventilation.
1. Prevention of aspiration and regurgitation
Intubation difficulty
1. Short muscular neck
2. Prominent mandible
3. Maxillary / protruding front teeth
4. Invisible uvula
5. Temporo-mandibular joint movement limited
6. Limited motion of the cervical vertebrae
Complications of intubation
1. During intubation
- Traumatized teeth
- Laceration lips, gums, larynx
- Stimulate the sympathetic nervous (hypertension - tachycardia)
- Bronchial intubation
- Oesophageal intubation
- Aspirations
- Bronchial spasm
1. After ekstubasi
- Spasm of the larynx
- Aspirations
- Disruption fonasi
- Subglotis-glottis edema
- Infection of the larynx, pharynx, trachea
Ekstubasi
1. Ekstubasi postponed until the patient is fully awake, if:
- Will return menmbulkan intubation difficulty
- There is the risk of aspiration post ekstubasi
1. Ekstubasi done on the state of anesthesia is generally mild with notes will not occur spasm of the larynx.
2. Before ekstubasi, clean the oral cavity - the larynx - the pharynx of secretions and other liquids.
Comparative properties of airway equipment
Front lid lid Larynx trachea Pipe
Interventions should be held no need to hold No need to hold
Pretty good quality airway Very good or good enough
Access to the head neck Good Good Poor
Spontaneous ventilation is very short Procedure Procedure Procedure long long time
Ventilation control is very short Procedure Procedure Procedure very long time
------------------------------ Concept Mechanical Ventilation
In the medical field, mechanical ventilation is suau method to assist or replace spontaneous breathing. Mechanical ventilation is performed as a life saving action in CPR, intensive care, and anesthesia.
Clinical Use
Used in mechanical ventilation if spontaneous respiration is not obtained (apneu) or inadequate. This could be a result of intoxication, cardiac arrest, neurological disease, head trauma, respiratory muscle paralysis in Guillain-Barré syndrome, Myasthenia Gravis, spinal cord injury, or the effects of anesthetic and drugs Muscle relaxants. Various lung diseases (eg Pulmonum edema, COPD) or thorax trauma (eg broken ribs), and heart disease such as congestive heart failure, sepsis and shock can also hinder normal ventilation. Depending on circumstances, mechanical ventilation may be continued for several minutes or even several years.
