COPD w/ high flow O2

[medic417]

You've seen a patient with COPD deteriorate, from high flow oxygen administration?

Yes I have, 10-15LPM (not truly high flow except in the EMS field ) on NRB and somewhere between 45-60 minutes into trip to our nearest hospital they stopped breathing. As stated not really a big deal just remove O2 and bag a couple of times and they will usually resume normal respiration's.

Now if you panic and tube them that is an unnecessary tube. Now if after bagging w/o O2 for a time and they still do not resume breathing tube them as something more serious is going on.

Oh always check pulse to make sure it is just the Hypoxic drive and not cardiac arrest. Would look bad if you show up bagging a patient but not doing compressions on a pulseless patient.

 

[Aidey]

Hey all

Picked up a 84 y/o m with COPD last night who was having trouble breathing pretty badly last night I believe his O2 sat was 80% he was on home oxygen 3lpm NC...so as I was taught by some medics we bust out the NRB 10-15 lpm which brings up his 02 sat and he feels much better for the time being. We have a 2 min trip to local hospital in which the nurse immediately switches back to 4-6L via NC.

We ended up showing up a few hours later to transfer him to the heli pad to a larger faciliaty when we arrived he was back on the NRB at 10lpm and so forth.

It may have been as simple as the nurse was trying to find the lowest amount of O2 the pt needed. I have done the exact same thing myself. We and a pt with a SpO2 of 88% is on 15pm. In the amb I will often take off the mask and put a cannula on and see how the pt maintains. If they don't they get the mask back, if they do then they keep the cannula. Generally the only time I will put a mask on a pt right off is if they are cyanotic.