COPD + oxygen delivery device?

[zippyRN]

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

i'm with rid on this , but then again this is probably due to one of the regulars who wonder's why we don't pander to him when he dials 999 with difficulty breathing - the whol shoutign in full sentances tends to blow the actual physical problem iside of it all out the water

[Asysin2leads]

I guess I'm losing everyone here. Here's my point. If you have a sick COPDer, giving them oxygen will not hurt them. It is really not necessary for the average EMT-B to get bogged down in hypoxic drive and CO2 offloading when treating at the BLS level. I'm not saying that every COPDer who calls 911 is having an exacerbation of their COPD, I'm saying that if a COPDer is to the point of calling 911 because of their respiratory problems, generally they will require oxygen, panic attacks not withstanding.

I think there are far, far, far, far, FAR more COPDers who have oxygen withheld by well meaning but misguided people then COPDers who have been harmed by giving high flow oxygen. Don't automatically give everyone high flow o2, if not for the only reason that its a waste of o2. Treat according to presentation, and if they present with dyspnea, give them the oxygen.

[Punisher]

Two things to keep in mind:

1. If they need oxygen by their clinical presentation- give it to them. There is only a VERY small minority of COPD patients that are relying upon hypoxic drives to breathe, i.e. you won't hurt them by giving them supplemental O2.

2. Most (up to 85% depending on the study you rely upon) of COPD patients have some manner of psychological illness- usually a panic disorder of one form or another. Some researchers theorize that more than a few of the COPD exacerbations we see may actually be misdiagnosed panic attacks.

If anyone wishes to see the documentation backing up this, let me know.

[AnthonyM83]

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...

Don't punt a skunk either...there was a football player at my school who did that....bad idea.

[Para-Medic]

I think I understand evaluating a patient and supplying what is needed. Still, I don't think I would withhold O2 from a patient at the beginning of my assessment. I mean, let's say we have a call 78 YO Male with COPD who has a C.C. of SOB. As soon as I arrive. I ask what's wrong and listen to what they have to say while evaluating. I would check airway, breath sounds, O2sat (this wouldn't take long). Then as soon as Im done evaluating respiratory I would give them O2. While taking the rest of their vitals/history/meds/evaluation I would monitor how the O2 would help them. Depending on how the O2 affects them is when I would make the decision on keeping them on O2 or not. Still, I probably wouldn't take them off the O2 because our paramedic would immediately ask us why this patient that called with SOB didn't have O2 on. Would you all consider this to be a reasonable way of treating the patient stated above?

[Dustdevil]

No. Once it is on, it stays on. Rapid fluctuation of oxygen intake is not consistent with the principle of homeostasis. It taxes the system. You simply have not the sufficient means nor knowledge to properly evaluate the patient in the depth necessary to reduce or remove their oxygen. They need to be at the hospital and have blood gasses evaluated before that happens.

[Para-Medic]

No. Once it is on, it stays on. Rapid fluctuation of oxygen intake is not consistent with the principle of homeostasis. It taxes the system. You simply have not the sufficient means nor knowledge to properly evaluate the patient in the depth necessary to reduce or remove their oxygen. They need to be at the hospital and have blood gasses evaluated before that happens.

Yeah, that's what I thought. I really just do not know enough about it to make such a decision. What about lowering the LPM?

[Ace844]

Yeah, that's what I thought. I really just do not know enough about it to make such a decision. What about lowering the LPM?

These threads should answer your questions::

http://www.emtcity.com/phpBB2/viewtopic.php?t=2657

http://www.emtcity.com/phpBB2/viewtopic.php?t=2401

hope this helps,

ACE844

[icebergmedic]

What about SpO2? do you have an oximiter on your rig? As a Basic I can see where your concern is... Is Ridrider an RT now too? More small letters to add behind his name....

[jules1977]

COPDer...Hmmm

Well, I would have to say, and I am willing to argue, if a person is in severe resp distress....Give them O2. That would be by NRB, no matter the Hx. Sure COPDers rely on their hypoxic drive to breathe. But one must realize that if they are truly SOB their PO2 will be significantly lower than what it should be. O2 will not hurt for the amount of time you will be with the pt. It will help. I would guess that no one is going to be with these people for hrs, so there is no need to worry. That is what it would take to knock out their hypoxic drive. And who really cares if you did....Bag them and fix it. It is not that bad of a problem.....Maybe if you intubate them it will cause problems, that is much more invasive than you need....And besides, I challenge someone, with out exagerating, to tell me a time that a NRB actually caused someone not to breathe.

The whole hypoxic drive theory causes way to much worry. We all know that as soon as we get to the hospital, regardless of how low the PO2 is that the nurse will take off the NRB and put on a NC because she will be worried about it. They are the same people who see an SPO2 of 45% and believe it. And we all should know that this is not conducive to life....peripheral constriction anyone????