I really think your misinterpreting what I was saying. And have missed other post so there for you are making good arguments but not valid to our particular discussion. Obviously very knowledgable but my point still remains that O2 administration to the pt with copd in the pre hospital setting is enough to effect there hypoxic drive into respiratory arrest..
I understood this point.
My point is that there is a very specific patient population that EMS probably very rarely sees where the oxygen given to a COPD pt can cause harm.
As pointed out in my statement, these patients are often found hospitalized, however, they may be found occasionally in long term care facilities.
As I am sure you have discovered responding to most nursing homes, the staff there usually know very little about their patients, if anything at all. So it is not unreasonable to explore the possibility that any given patient found there may potentially be from this very limited COPD population.
Also consider subclinical effects that EMS does not see, but subsequent providers must deal with.
To further clarify in a long transport situation I would hope that you would a pt history that included there copd and you would follow the guidelines of that piticular pt o2 administration that many live with..
If I may?
I would suspect that if the pt had COPD and was having an acute exacerbation in the prehospital environment and they were normally on o2, that their Po2 would be abnormally decreased from their baseline to cause a worsening of symptoms.
In particular to history, since home oxygen therapy permits symptomatic relief and increases quality of life on a temporary basis, how long they have been on home oxygen as well as their presentation would probably lead me to positive pressure being the better treatment choice. If given the ability to adjust oxygen content, I would try a slight elevation in the amount of oxygen provided they didn't look like an end stage "blue bloater" which I have been specifically educated to recognize as the subset of COPD patients that will be harmed by high flow oxygen administration.
It stands to reason that if a COPD patient who is normally prescribed oxygen is having an exacerbation significant enough to activate 911, then their current oxygen dose must not be adequete?
In all likelyhood, assuming the non specific subset of COPD patient, and absent a positive pressure device, I would elect to increase the amount of oxygen being administered from their normal prescription.
What I would certainly not do is put them on 15l of NRB. That is like using a cannon to kill a mosquito. As I pointed out, it can also cause pulmonary injury that appears post EMS contact. Patients with long term COPD don't have a percent or two of pulmonary reserve they can spare and are already suseptable to infection and inflammation without adding superoxide to the equation.
