Was I wrong?

[nsmedic393]

Sounds to me like you weighed the patients needs vs the patients physical condition and delivered appropriate care that ended with a positive result for the patient.

Around here we call that a good clinical decision. Insert thumbs up here....

[medik8]

Juice...I think you did a fine job. :thumbup: Especially considering your patient's lack of cooperation. lol. I wouldn't have razzed you at all. Don't freak out about this. Volley Bob is obviously a nimrod. :knob:

:wink: 8

[Dustdevil]

I know I am starting an argument that I will not win. I am not implying that you should withhold oxygen because of fear of decreasing hypoxic drive. My point is that there is no harm in titration of the oxygen, if the patient is not in severe distress or respiratory arrest. Let me have it Dusty, I enjoy your knowledge and experience that you bring to this forum.

Did you read the scenario? What on earth gives you the impression that this patient was not in severe respiratory distress? I can't imagine that anybody else here got that idea. He's stopped working. He's struggling to speak because of his dyspnea. He's hypoxic enough to be in a panic about a mask over his face. And his Sp02 is 72!

Yes, you can titrate oxygen. But you titrate it DOWN, not up! It's been that way as long as I can remember. This is nothing new. Oxygen is not like other drugs where you have to titrate up because high dosages will be harmful to the patient. Oxygen is the very opposite, in that dosages too LOW will be harmful to the patient. Use your head. Think this through. Tell me one single medical or scientific principle that would make you think being stingy with oxygen on an asthmatic is a good idea. I want to hear your logic.

[ncmedic309]

A NRB mask and high-flow O2 would have been most appropriate for this patient, it appears you gave it a try and the patient wouldn't take it, good enough. You made the attempt and got a little bit of O2 going. It doesn't sound like you did anything wrong. This patient was in respiratory distress and high-flow O2 is indicated. Knocking out his hypoxic drive (COPD patient) should be the least of your concerns. It will take a prolonged amount of time (we're talking hours and hours) before high-flow O2 would possibly do this patient harm, even if then. If they are hypoxic, they get O2.

[Dustdevil]

Not to mention the little fact that this was not a COPD patient. It was an asthmatic.

Hypoxic drive is not even a concern in this patient. And even if this were an emphysema patient, the treatment would be exactly the same.

[ncmedic309]

My little tanget about the COPD patients hypoxic drive was in regards to medic5587's post, I got the part of the scenario where the patient has asthma...but while were at it...

Here's a debate for you...

COPD is more or less a triad of several other diseases, more specifically asthma, emphysema, and chronic bronchitis. So would you be wrong if you considered this a COPD patient? Explain your rationale...

[Guest DELETED]

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[Cookie]

From one basic to another, I think you did fine by your patient. On the cannula his o2 sats went up and stayed there. He was able to refuse to be transported and agreed to a breathing treatment. I would not worry about it nor try to second guess yourself. Dust has as much as told you that. Just be sure you DOCUMENT, DOCUMENT DOCUMENT everything.

As for the other guy, forget him. Maybe it could have been handled a little differently, but we all have said or done things that could have been handled a little diffferently a time or two. I'd let it go and move on.

[noahmedic]

I think you did a great job.

[Jeep_911]

meh...hypoxic drive takes over and they stop breathing....bag'em