Oxygen supplementation

Figure 12.4 Gas flow in the BioWave reactor under oxygen supplementation...

For simple GHB ingestion in a spontaneously breathing patient, intubation (insertion of tube into the trachea) may not be necessary. In these cases, management may include positioning the body to reduce the risk of choking, oxygen supplementation, monitoring, stimulation, treatment for persistent bradycardia (abnormal slowness of the heart), and admission to the hospital for observation. 

Deep narcosis occurred in dogs, cats, and monkeys exposed via inhalation at concentrations of 500,000 ppm within approximately 1 min the recovery period was approximately 2 min (Shulman and Sadove 1967). In a review of preclinical toxicology studies, Alexander and Libretto (1995) reported no deaths or treatment-related effects on clinical signs, body weight, food and water consumption, or postmortem findings in rats and mice exposed via inhalation at a concentration of 810,000 ppm with oxygen supplementation for 1 hr. Male and... 

Ali K, Roffe C, Crome P (2006). What patients want consumer involvement in the design of a randomized controlled trial of routine oxygen supplementation after acute stroke. Stroke 37 865-871... 

There is no known laboratory test available that can confirm diphosgene exposure. However, evaluation of oxygen saturation and arterial blood gas is recommended for initial treatment for all patients. When inhaled, the patient should be removed to fresh air area immediately. Oxygen supplement can improve tissue oxygenation and reduce the damage due to hypoxemia in patients. Artificial respiration devices with or without positive pressure should be used if necessary. 

Patients unresponsive to steroids are given immunosuppressive agents (azathioprine and methotrexate). These drugs have had limited success, and unfortunately, they also have a high incidence of side effects. Nonspecific therapies include oxygen supplementation, bronchodilator therapy (e.g., theophylline) if there is concomitant chronic obstructive lung disease, and prompt antibiotic therapy if an infection is associated with the disease. 

Therapeutic strategies are discussed below. Hospitalization, oxygen supplementation, nebulized bronchodilator therapy, corticosteroid therapy and occasionally intubation are required for severe attacks. 

Oxygen supplementation should be provided to maintain a Po2 greater than 60 mm Hg. Very early application of positive end-expiratory pressure (PEEP) is important, with progression to intubation and positive pressure ventilation if PEEP fails to normalize the Po2. Note that PEEP application may precipitate hypotension in individuals with marginally adequate intravascular volume (such as those with conventional trauma or pulmonary edema) or in individuals previously treated with drugs that have venodilating properties (such as morphine or diazepam). Particular attention to anemia is necessary if hypoxia is present. 

After a toxic inhalational exposure, exercise may further compromise the patient. Hypoxia is a primary factor. Oxygen supplementation is necessary at rest and especially during exercise. Exercise may aggravate the effects of toxicant exposure and should be limited or restricted if possible. 

Hypoxia improves as the bronchospasm improves, and long-term oxygen supplementation is rarely required. If long-term oxygen supplementation is needed, a search for other causes of hypoxia should be undertaken. Early institution of positive airway pressure (such as using a PEEP mask) may be useful. Positive pressure ventilation may be necessary if PEEP is insufficient to maintain Po2 greater than 60 mm Hg. Occasional reports of subcutaneous emphysema after chlorine exposure should not... 

Oxygen supplementation is provided for evident hypoxia or cyanosis. Expeditious fluid replacement is mandatory when hypotension is present. Combined systemic hypotension and hypoxia may damage other organ systems. Bacterial superinfection is sufficiently common to warrant careful surveillance cultures. There is no literature support, however, for use of routine prophylactic antibiotics. 

In Uhllg s earlier view, one of the factors determining passivation (and chemisorption) is the ratio of the work function to the enthalpy of sublimation AH. If this ratio is less than unity, conditions are favorafle to passivation because the electron would escape more readily than the atom, favoring the chemisorption of substances like oxygen. A passive film is composed, then, from chemisorbed atomic and molecular oxygen (supplemented perhaps by OH and H 0). The formation of chemical bonds satisfies the surface affinities of the metal without metal atoms leaving their lattice site. 

In a study of 16 surgical patients, 8 took oral clonidine 4 to 5.5 micrograms/kg 90 minutes before their operation. Anaesthesia was induced by thiamylal, and maintained with nitrous oxide/isoflurane/oxygen supplemented by fentanyl. Clonidine increased the duration of neuromuscular blockade following the use of vecuronium by 26.4%, when compared with the patients not taking clonidine. ... 

Treatment for the respiratory damage involves oxygen supplements, intubation, and artificial ventilation when indicated, as well as the use of a hyperbaric chamber to remove carbon monoxide, if needed. Any restriction to the chest owing to burned skin is removed surgically. The nurse must monitor arterial blood gases and oxygen saturation levels to determine the effectiveness of treatment. In addition, the nurse should monitor for signs of acidosis and related acid-base imbalances. <3 ... 

M. F. Oliveira, M. K. Rodrigues,E. Treptow,T. M. Cunha, E. M. V. Ferreira,and J. A. Neder, Effects of Oxygen Supplementation on Cerebral Oxygenation diu-ing Exercise in Chronic Obstructive Pulmonary Disease Patients Not Entitled to Long-Term Oxygen Therapy, Clin. Physiol. Fund. Imaging, 32,52 (2012). 

OHS may present with various possible sleep respiratory patterns (obstructive apneas, hypoventilation, and sometimes, central apneas, or a combined pattern) (7) and needs polysomnographic evaluation to adapt the ventilatory treatment, which is then mandatory (Fig. 3) either as nasal continuous positive airway pressure (nCPAP) or bi-level positive airway pressure ventilation, generally with oxygen supplementation if severe desaturation is present. 

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