COPD + oxygen delivery device?

[Para-Medic]

Hi everyone,

I was reading the "was I wrong" thread and a question popped into my head. I know that there is a large debate on COPD patients and oxygen (because of oxygen/carbon dioxide retention). So there is always a debate on what device should be used on them. Of course, if the patient is in distress NRB, but what if you have a copd patient with low O2sat without any signs of distress? Canula comes to mind, but would it make a big difference if you had the patient on a NRB instead?

[ncmedic309]

It all comes down to treating your patient, a good thorough assessment on these patients will guide you to the proper care. If they are not in distress, is a mask really warranted? Sure their sats might be 89%, but does that mean that the patient needs high-flow O2 right away? Maybe, maybe not, what else is their presentation like? If you went with it anyway, you wouldn't harm your patient. The myth about knocking out the hypoxic drive of COPD patients is just that, nothing more than a myth, at least for us prehospital providers. I guess it's always possible that too much O2 could harm the patient based on the pathophysiology of the disease, but even so, it would be after a really prolonged administration of high-flow O2. More or less, we shouldn't be concerned with it in the field, if the patient needs high-flow 02 then they get it, putting a nasal cannula on a COPD patient in moderate to severe distress is poking a skunk, and we all know that poking skunks is never a good idea...

[Para-Medic]

could keeping a patient, who has COPD and had difficulty breathing, on high flow O2 even AFTER he felt and looked better be harmful for the patient?

[nsmedic393]

I think the worst that could happen is that their hypoxic drive kicks in and they stop breathing. If you are monitoring your patient, not a big deal. Bag them up or remove the mask and allow the CO2 levels to rise and they will start breathing again.

I think the big uproar with O2 and COPD comes from nursing/hospitals where they may not be monitoring their patient every minute and if they put a NRB on a COPDer and walk away to tend to other patients, should the patient stop breathing you would have a situation.

[vcfd35s]

Like mentioned before, keeping a pt on 02 after they have shown signs of improvement will not harm the pt. basically, it all boils down to if there pt can keep there vitals stable w/o 02. But, believe you me, if I were to take my pt off 02 and there vitals started to fall, the mask goes right back on.......im only a student who is studying to be an EMT....just my 2 pennies...so take it for what its worth...

[noahmedic]

could keeping a patient, who has COPD and had difficulty breathing, on high flow O2 even AFTER he felt and looked better be harmful for the patient?

In the prehospital world, no. In the long-term or critical care world, maybe.

The bottom line in this case is to treat the patients acute distress. More O2 will not harm them so if they are having respiratory difficulty start will a NRB, you will not hurt them during the short transport time.

[nsmedic393]

I think the worst that could happen is that their hypoxic drive kicks in and they stop breathing. If you are monitoring your patient, not a big deal. Bag them up or remove the mask and allow the CO2 levels to rise and they will start breathing again.

I think the big uproar with O2 and COPD comes from nursing/hospitals where they may not be monitoring their patient every minute and if they put a NRB on a COPDer and walk away to tend to other patients, should the patient stop breathing you would have a situation.

And to address the question about a COPDer who is not in distress and has a low O2 sat. Why are they calling? I find if a COPDer is calling because they have SOB they are usually really sick. They deal with SOB daily. Now if the patient is calling because they havn't had a BM in a week and their O2 sat is 75%. They get whatever dose of O2 they are getting at home.

[Para-Medic]

ok thanks for answering my question. I asked this because I remember we once had a patient with COPD, c.c. was something psychological, and when I saw her sat I just freaked (this was when I was barely starting). So I put her on some O2 NRB. When we arrive at the hospital my partner said that it was bad for me to have given her o2 due to possibility of CO2 retention. That if I had to give her O2 to do it with nasal. I thought, well O2 is O2, if I see her getting worse I'll take it off. Her o2 sat returned to normal but I forgot to lower the setting from 15 to 10 (I think it was 15 or 12). Since then I always wondered if there is any proper procedure for giving O2 to COPD patients.

[Para-Medic]

And to address the question about a COPDer who is not in distress and has a low O2 sat. Why are they calling? I find if a COPDer is calling because they have SOB they are usually really sick. They deal with SOB daily. Now if the patient is calling because they havn't had a BM in a week and their O2 sat is 75%. They get whatever dose of O2 they are getting at home.

It was for this psych patient I mentioned. I think she had a broken wrist for some reason but I cant remember.

[Nate]

Don't forget to look at transport time! If you are going to see transports that are going to take a while a venturie (spelling?) mask might be of better use since you can regulate the percentage of oxygen they are getting. Usually you'll see them used in rural areas with lettings around 8-12 LPM at 30 to 45% oxygen (don't hold me to that, we don't carry them).

You have to look at more then just Sa02 for proper perfusion (capnography would be nice here). Also check to see what their current settings are, most of the times you get someone with COPD who has just exerted themselves to much and is only on 2-4 LPM with 100' of oxygen tubing. So if you put then on a regular NC at 4 LPM and let them rest you'll notice that their Sa02 level will go up.

COPD management is best treated on a case by case basis.