COPD Patient

[briguy222]

I just wanted to get some feedback on a certain scenario we had on a call with a COPD patient...

We were dispatched to a call involving a patient with COPD who stated he was having trouble breathing on his in-home oxygen unit which was set at 3 lpm via nasal. We then put him on our own oxygen at 15 lpm via nonrebreather. After a couple minutes I asked how he was feeling and he stated that he felt much better. Shortly after, the paramedics arrived and walked into the room asking what was wrong. I told the medic that he has COPD and the medic bit our heads off asking why we had him on high flow oxygen.

To my understanding, it is ok to give a patient like this high flow oxygen. I am also aware of the chance of knocking out the hypoxic drive, but if the patient wasn't getting enough oxygen with what he was already on, what are you supposed to do?

I just thought that I would throw this out there and see what others say. Were we right or wrong in what we did and should we have even put him on oxygen? I was taught to never deny a patient of oxygen and that is usually one of the first things needed to be done.

[Spazz3z]

yea i was there with Bry so we're curious... i remember no matter what the call give them O_{2 and monitor them from their but this is why i dont like Paramedics... cause they think they are gods and i wanna just kick him in the head.... but yea give us feed back please...}

[AZCEP]

The next time this happens, in your most innocent, unknowing EMT posture, ask this tool of a paramedic how long does it take to knock out a patient's hypoxic drive?

The response will be priceless, I promise.

You did right. If the patient can't breathe, then they get oxygen. Only one relative contraindication to oxygen administration, and I'm betting this patient wasn't inhaling paraquat so they get it also.

Keep in mind this idiot paramedic was an idiot before he became a medic, so it wasn't the paramedic part that made him act the way he did.

[Spazz3z]

thank you i wanted to hit him but i couldnt due to the fact he was like twice my size and i had a PX to treat... but thanks for clearing that up you were a big help...

[briguy222]

...one more thing,

i know scenarios can change and peoples reactions can differ, but is there and average time it takes for someones hypoxic drive to get knocked out and if so how long does it usually take until it does?

[MedicRN]

Generally it can take many, many hours. Usually longer then EMS will ever have their hands on the patient.

[Coach Hohman]

I had this exact scenario this week...a patient with COPD, CHF, Asthma...you name it...he had it, including lung cancer. Was on home O2 2LPM. I got a saturation level of 86%, which is probably average for his conditions and put him on a NRB @ 12 LPM. By the time we got to the hospital (35 minutes, long story...pt. wife refused nearest facility and after a brief debate, I got overruled because I wasn't "on call" but it was across the street) So..we get to the hospital his saturation level is at 98% he's not working nearly as hard to breathe and he's no longer cool and clammy. Well, I'm telling my mom about it (who is an EMT-I for the past 20 years) and I got lit up for putting him on that much O2 for so long. We had the hypoxic drive debate, and I still think I'm right. I'm going to have to show her this post!

[chbare]

I still do not understand the whole hypoxic drive thing. People still spout off "do not give COPD patients oxygen" like its dogma. Like MedicRN stated, you are looking at several hours to wipe out the patients drive. This thinking is still encountered in the hospital as well. I had a nurse take a NRB off of my patient because the patient had COPD. I put the NRB back on and told the nurse not to touch my patients without asking. I also told her you give patients oxygen if they need oxygen. If by some act of God they stop breathing 3 minutes into receiving high flow oxygen, I am sure I can figure out how to use that inflating bag thingy and a flexible nose tube thingy to breath for them. :roll:

Take care,

chbare.

[Ace844]

For those whom would like to learn abit more about this you can start here::: http://www.emtcity.com/phpBB2/viewtopic.php?t=2657

Hope this Helps,

ACE844

[madmedic8522]

my thought exactly chbare, even if you did knock out the hypoxic drive while waiting for the two paragods to get there, you should have been able to help that situation as well. good job always give your pt o2!!

madmedic