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O2 administration

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My area wants us to maintain SpO2 at 94% or higher, but we do not have to. Some paramedics in this area will not give oxygen for certain cases because of its harmful effects, especially when it comes to copd pt's.

In the case of COPD patients, keeping the SPO2 in the high 80s to low 90s would be the preference because that's their normal saturation levels. Secondly, withholding Oxygen for fear of disrupting the hypoxic drive is beyond naive. It's just plain stupid. We never have a COPD patient in our care long enough to disrupt the hypoxic drive. I'm surprised that there are still medical professionals who think like this.

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Good point Trev but it would prove prudent to be judicious with oxygen administration in COPD patients, the target seems to be 90-92% unless they have specific instructions on an oxygen alert card from their respiratory physician and to turn the oxygen down between nebules if you are giving them salbutamol/ipatropium

I did a rather large research assignment on COPD when I was at uni, it is rather interesting

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I'm with kiwi on this one. We titrate to 95% (92% for COPD patients). Anyone 95% or greater on room air doesn't need supplemental oxygen.

The only real caveat is with suspected carbon monoxide poisoning.

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As artickat has stated, we don't have COPD patients in our care long enough to interrupt the hypoxic drive. I really don't understand why pre-hospital people still believe that. If they are working hard to breath, in the short term, 12 liters by an NRM is not incorrect. If they cant tolerate a mask, then a cannula at 6 liters is not incorrect. With CPAP, we give 20 liters through the mask routinely and can inline an SVN with it. It's the long-term effects that most hospitals are concerned with, hence why they put the patient back on thier normal 2 or 3 liters by cannula almost immediately. But the 10, 20, 30 minutes of getting high flow O2 isnt going to hurt them pre-hospital.

newborns that are on high flow oxygen for long periods of time can also be badly effected. Its actually blindness but its one of those million dollar words that ties my tongue up when I try to say it. :/

I always go with what the patient is comfortable with, whether it be an NRM or a cannula. But we arent allowed to titrate to effect, which really irritates me. They dont always need the highest liters to help them.

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The term you are looking for is retinopathy of prematurity

Terri, you are not wrong per-se but I would still caution the judicious use of oxygen in a patient with known respiratory failure secondary to hypercaponea; ten or twenty or thirty minutes on supraphysiologic amounts of oxygen (i.e. fifteen litres cramed down their gob by NRB) could well have the bad respirojuju

And I always thought PEEP and CPAP were measured in cmH20 rather than litres?

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We can do 10cmH20 without an order, for anything higher than that we have to ask, however the setup comes straight off the main o2 tank at about 20 liters a minute, there is no way to make it less. Thats why the 5 or 10 cmH2o. With a patient that I know is a COPD patient, I am hypervigilant. I always watch them closely. If they are having too much trouble coping with 15 liters I will drop them to 12. IF thats still too much then I will put them on a cannula at 6, and I watch the SPO2 as well. I dont want them at 99%...I want them in the low 90's where they usually are and if I can achieve that, great.

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We can do 10cmH20 without an order, for anything higher than that we have to ask, however the setup comes straight off the main o2 tank at about 20 liters a minute, there is no way to make it less. Thats why the 5 or 10 cmH2o. With a patient that I know is a COPD patient, I am hypervigilant. I always watch them closely. If they are having too much trouble coping with 15 liters I will drop them to 12. IF thats still too much then I will put them on a cannula at 6, and I watch the SPO2 as well. I dont want them at 99%...I want them in the low 90's where they usually are and if I can achieve that, great.

Precisely why I'm not really a fan of O2 driven CPAP systems like the boussignac. A patient benefiting from positive pressure doesn't mean they also need to be hyperoxygenated.

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Straight from my class: never withhold O2

I've always been under the impression that cardiac pts get 15 lpm nrb. That's what they aught me in basic.

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Straight from my class: never withhold O2

Philosoraptor asks is it really withholding supplemental oxygen if supplemental oxygen isn't indicated in the first place?

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