tailieunhanh - OXY LIỆU PHÁP (PHẦN 5)

Khi sử dụng oxy thì khả năng nhiễm khuẩn cao vì vi khuẩn phát triển nhanh trong môi trường khí oxy và dễ dàng xâm nhập vào bộ máy hô hấp đã bị tổn thương sẵn. Do đó cần đề phòng nhiễm khuẩn bằng cách: dụng cụ vô khuẩn, sau mỗi lần thở dụng cụ phải được làm sạch và tẩy trùng. Tốt nhất là chỉ sử dụng 1 lần. Thay ống thông và đổi bên lỗ mũi 8 giờ/lần. Làm vệ sinh miệng cho bệnh nhân 3-4 giờ/lần | Table 3 COPD and other conditions requiring controlled or low-dose oxygen therapy section Prior to availability of blood gases use a 28 Venturi mask at 4 l min and aim for an oxygen saturation of 88 92 for patients with risk factors for hypercapnia but no prior history of respiratory acidosis. Grade DJ Adjust target range to 94 98 if the Paco2 is normal unless there is a history of previous NIV or IPPV and recheck blood gases after 30 60 min Grade DJ Aim at a prespecified saturation range from alert card in patients with a history of previous respiratory acidosis. These patients may have their own Venturi mask. In the absence of an oxygen alert card but with a history of previous respiratory failure use of NIV or IPPV P treatment should be commenced using a 28 oxygen mask at 4 l min in prehospital care or a 24 Venturi mask at 2 4 min in hospital settings with an initial target saturation of 88 92 pending urgent blood gas results. Grade DJ If the saturation remains below 88 in prehospital care despite a 28 Venturi mask change to nasal cannulae at 2 6 min or a simple mask at 5 min with target saturation of 88 92 . All at-risk patients with alert cards previous NIV or IPPV or with saturation 88 in the ambulance should be treated as a high priority. Alert the A8E department that the patient requires immediate senior assessment on arrival at the hospital. Grade DJ If the diagnosis is unknown. patients aged 50 years who are long-term smokers with a history of chronic breathlessness on minor exertion such as walking on level ground and no other known cause of breathlessness should be treated as if having COPD for the purposes of this guideline. Patients with COPD may also use terms such as chronic bronchitis and emphysema to describe their condition but may sometimes mistakenly use asthma . FEV should be measured on arrival in hospital if possible and should be measured at least once before discharge from hospital in all cases of suspected COPD. Grade DJ Patients .