nasal cannula debate

[EMTB7]

8 lpm?! Holy nosebleed, Batman! I had never had a cannula and I wanted to see what it was like... cranked that thing up to about 6 or 7 and I was about to jump out of my skin. I couldn't imagine having it on 8. My class (got out in August) was taught 1-4 lpm. 8... yikes.

Jonathan

[Chief1C]

The 1968 Ambulance Attendants Manual suggest only giving 10 LPM by plastic mask to victims requiring oxygen therapy. The 1971 AAOS Emergency Care book doesn't mention flow rates, nor does it mention the use of a Nasal Cannula. The 1978 Brady, Second Edition, suggests flowing oxygen at a rate of 6 to 8 LPM, via nasal cannula. The Brady Fourth Edition suggests 4 to 6 LPM, via nasal cannula. The Brady Eighth Edition suggests 1 to 6 LPM, via nasal cannula.

[Kiwiology]

4lpm max on an NC here

[HellsBells]

I typically set the NC flw rate @ 4LPM, I have maybe used 5 or 6LPM a couple times, but for any higher doses I start an NRB.

On a similiar topic, does anyone here use a simple face mask? Or do you go directly to an NRB?

[Richard B the EMT]

A seminar I just attended gave the impression that cannulas and Venturi masks might be coming back into the forefront, as the NRBs might be delivering too much O2, causing problems.

[VentMedic]

The hospitals have been switching to the Oxymask. You can start high at 15 - 20L and wean down to 1 L without changing the device. The patient can also be suctioned, have a bronchoscopy or eat and drink without removing the mask.

http://www.southmedic.com/products/oxymask-adult.php

Comparison of Oxymask and VentiMask

http://www.pulsus.com/journals/abstract.jsp?jnlKy=4&atlKy=6894&isuKy=365&isArt=t&HCtype=Consumer

[tamaith]

so at one point the max was 8 lpm. wow. thank you.

[emtgrimreaper]

Here's one for you. I have a patient thatI transport that requires 10 lpm via a n/c. It is a special one but it is rated for 12 lpm. So yes I have seen it first hand

[tniuqs]

Interesting all these Oxygen queries as of late ... as Ventmedic mentioned there are devices like the Optimizer type N/C that can be set at much higher levels than some "protocol" these include concepts like the Venturi effect (flared tips) and some have diaphragms that upon inspiration allow an increased reservoir flow upon inspiration, of this I know well because I had the extreme pleasure of wearing one for 2 weeks ... that said.

Generally speaking the reservoir in the standard anatomy the naso and oro pharynx is flooded with flows equal to 6 lpm (some books say about .40 for FiO2)higher flows over 4 are generally quite uncomfortable, although longer term the "over the ear" tubes are far more uncomfortable and can lead to skin breakdown (just in passing personal commentary)

Now using common sense if a patient does not tolerate a mask ... and many patients feel they are being suffocated, besides they smell like chemicals ... so if a patient does not tolerate a mask and they require and tolerate 8 liters per minute well who's going to quote "some book" if it works.

Use a pragmatic approach in respiratory care is my humble opinion.

cheers

[Dustdevil]

Generally speaking the reservoir in the standard anatomy the naso and oro pharynx is flooded with flows equal to 6 lpm (some books say about .40 for FiO2)

Hehe... except for RTs, my students are the only medics I've ever known to understand how to estimate the FiO2 delivered by an N/C. It's a crime that more don't.