COPD + oxygen delivery device?

[Ridryder 911]

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.

As others has noted, you probably will not "knock out their hypoxic drive"or give them oxygen toxicity. But please treat accordingly. These are the reasons some of us old timers and studious medics want more education level. Knowing about hypoxic drive, normal saturation range for COPD patients as well as "psychological induced hypoxia" etc... is essential in EMS and emergency medicine. The treatment can be as diversified and should be based upon an individual treatment regime based upon each clients need and response... not a blanket or "cook book" treatment.

Personally, I agree with high flow until crisis resolves it self, then change to ( I prefer Venturi mask ) nasal cannula to wean them down... again, little things like a fan, or air vent blowing on them will aid more than the oxygen in some panic attacks. Remember the clients feel that they are "being smothered"... and any psychological intervention will help ans well as reassurance and being calm yourself... The old saying, if the Captain is calm, the crew will be calm.. is true.

I suggest reading on respiratory pathology, and some methods of treatment ... the Internet is full of respiratory phases (even with videos, etc.) there is no longer an excuse to be ignorant.

Be safe,

R/R 911

[Nate]

To bad NRB makers don't throw in the little adapter to make it a venturi mask. :wink:

[Asysin2leads]

I don't know what books these skells read or what bar they go to and get these kooky ideas about CO2 and hypoxic drive and stuff, but really this crap about giving oxygen to COPDers is truly infuriating.

COPD stands for Chronic Obstructive Pulmonary Disorder, as in there is a CHRONIC OBSTRUCTION in the lower airways. This is either caused by chronic bronchitis, where the alveoli get all plugged up with mucus, and emphysema where there is loss of elasticity of the lungs and death of the alveoli themselves, providing for less oxygen exchange.

The net result of either is LESS OXYGEN is diffusing to the cells in the lungs. In other words, in their normal state, it is harder for the person to get oxygen exchange than the normal person, and in an exacerbation state, it is REALLY hard for them to exchange oxygen. So, for $1000 and the game, what could this person possibly need? Ummmmm.... OXYGEN!!!

So take your CO2 retention and your hypoxic drive and all the other terms that make you sound smart, crumple them up and throw them out the window. If the person is having trouble breathing, give them oxygen. Sure, if they're just having some mild dyspnea and aren't gasping for breath, it would be in better medical judgement to use a nasal cannula rather than gassing them with an NRB at 15lpm, but asides from that, don't worry about it, give the old folk some oxygen and just LET IT GO!

They can't remember lung sounds or signs of shock, but that hypoxic drive/COPD thing, that always sticks in the mind, doesn't it?

[Ridryder 911]

The main reason they are taught (the same reason for nurses) to worry is, they are not being able to protect the airway..i.e.intubate. Yes, it is true we should try to if possible, avoid placing a chronic lunger in a vent... it is hell try to wean them off if ever.... but, you got to do what you got to do...

R/R 911

[Dustdevil]

Just to muddy the waters, I have more than once seen a COPDer misdiagnosed as a psych patient by providers, both pre-hospital and in-hospital. Could it be that your patient is acting combative because of hypoxia? Could it be that your patient is hallucinating because of steroid psychosis?

Could it be that we aren't teaching either one of those concepts adequately in EMT and paramedic schools?

[Para-Medic]

Just to muddy the waters, I have more than once seen a COPDer misdiagnosed as a psych patient by providers, both pre-hospital and in-hospital. Could it be that your patient is acting combative because of hypoxia? Could it be that your patient is hallucinating because of steroid psychosis?

Could it be that we aren't teaching either one of those concepts adequately in EMT and paramedic schools?

That is exactly what I thought about afterwards. Seriously, I really do wish EMT-B classes were more detailed in things such as pathophysiology, more anatomy, etc. I mean, our class was like 4-5 months long. Personally I think the reason they don't go too much into detail about it is because it would confuse us. Remember how I said my partner got mad at me for giving them O2 through NRB instead of nasal? Well, I think she just studied too much on COPD and CO2 retention, hypoxic drive, etc. and now would think about limiting the amount of O2 to give patient. Like Asys said just give them O2, that is what they need. If you have someone thinking about hypoxic drive and etc. they loose concentration on the main issue. Still, I think with the proper education we would all benefit from it.

[Ridryder 911]

Actually it would be the other way around... there should be no confusion, if you were taught properly the first time. Having a full understanding would not confuse one. One should know about hypoxia and respiratory drive etc.. yes, it does matter.. again, we should learn medicine and think outside the box. There really is medicine than pre-hospital environment and yes, we should also know that as well. Is it really asking to much to really know medicine ?

Again, with the advances of adjunct equipment such as EtCo2 , one can immediately see if there is Co2 retention and if they are really having an ventilation obstruction problem or a oxygen perfusion problem (v/Q). Again, knowledge in pathophysiology, disease etiology and detailed assessments may change treatment immediately. With a proper assessment and use of EtC02, I no longer use NRBM on most of my patients... there is no really no use to give a "high flow" for chronic lungers that are not in need of it. Again, appropriate treatment... not just treating.

Be safe,

R/R 911

[Asysin2leads]

Okay, maybe I tend to oversimplify things, but generally speaking, if a COPDer is to the point of dialing 911, don't you think giving them oxygen will figure into the equation somewhere along the lines?

[nsmedic393]

Okay, maybe I tend to oversimplify things, but generally speaking, if a COPDer is to the point of dialing 911, don't you think giving them oxygen will figure into the equation somewhere along the lines?

Like I said before, the COPDer that dials 911 for a respiratory problem is usually going to be really sick. They deal with having SOB every day and it will usually take an accute exacerbation before they call for help.

So, yes. Oxygen will definatly fit into that equation somewhere.

[Ridryder 911]

Actually, approximately >50% of what I see in COPD patients is more panic attacks than true exacerbation of the disease process. Again, a little more psychological TLCis needed more than traditional medical treatment. Just because someone dials 911 of course does not equal treatment. Common sense will dictate that if they are on pre-existing oxygen therapy, you will maintain it. If they are truly exacerbation state, you will need to relieve hypoxia, and treat accordingly.

Sometimes it is as comical as those that are on 2 lpm, with 15 feet of oxygen tubing. Only receiving a small portion of oxygen delivered. Psychological dependent more than physiologically in need.

Be safe,

R/R 911