COPD + oxygen delivery device?

[icebergmedic]

I'm an EMT... but... my Paramedic partner is also an RRT with greater than 10 years experience in ICU, weaning COPDers off of ventilators and working on chronic respiratory units.

This is what he teaches for the EMT the KISS method- (Don't withhold O2 it won't kill you) but he might!

1. Asthma "one part of the COPD triad" historically was believed to be psyc. in nature! WRONG!

1a Withholding O2 is asking for a law suite, the opinions expressed before that 50 % of COPD are panic attack related is "folly" I would panic too if I were SOB or perhaps having a silent M.I. ? COPDers have been known to Infarct!

(ps 47% of all stats are made up on the spot)

2. The venturi mask has gone the way of the "dodo bird" for good reason, serial blood gasses make chronics look like a "pin cushions" doing incremental 2% changes and then stabbing again.

2b. The only correct means of diagnosing CO2 retention and hypoxic drive is serial ABGs (hypoxic drive is a very rare bird!)

3. Nasal Bipap and full face is a currently is the prefered treatment in excerbation of COPD, in conjunction with broncho dialator therapy.

4. Atrovent may show better improvement in FEV 1/ FVC, than exccesive use of Sabutimol and have less systemic side effects like aggitation and axiety!

5. Inhaled steroids in early application have been proven to be more effective than previously understood and by numerous studies. (NEJM searches)

6. KEEP a SpO2 88 to 92 % "hey that rhymes" (look up the ODC) oxygen disassociation curve, available on a quick google search you will see why......he made me you can too!

7. ETCO2 is unrealiable in determination of PaCO2 (it should only be used as a trending device) this is BECAUSE of V/Q mismatch.....!

Quoting Punisher

2. Most (up to 85% depending on the study you rely upon) of COPD patients have some manner of psychological illness- usually a panic disorder of one form or another. Some researchers theorize that more than a few of the COPD exacerbations we see may actually be misdiagnosed panic attacks

See #1a

If anyone wishes to see the documentation backing up this, let me know.

I do, I have a royal flush, ICE BERG.

[Ridryder 911]

Is Ridrider an RT now too? More small letters to add behind his name....

No, but I write orders for them to follow.

R/R 911

[Guest]

No, but I write orders for them to follow.

R/R 911

[Ridryder 911]

Don't disagree with the statements of treatment at all. The remark for a newbie, does not affect me.. when and if you pass the boards then you can post them as well .

R.T. here are of usually 2 types .. technicians and therapist. Technician's which most hospitals employ are just that. Nothing to imply anything wrong with them, but most are not college educated, most are in-house trained or on the job training. I know there are several R/T's that are outstanding (a few here in the forum :wink: ) but there are also several that just are very poorly trained (just like EMS). The therapist is usually an associate degree program, there are a few university programs here for that.

I don't disagree that most have a very knowledgeable understanding in the cardiopulmonary systems. As well as they should have; it is their speciality. As far as writing orders, Clinical Nurse Specialist, Physician Assistants, Nurse Practitioners may have prescriptive rights or even privilages to write orders, prescriptions, treatments for patients. Several Internist, Cardiologist, Pulmonolgist hire P.A.'s or CNS, NP's , that makes rounds for them and will review charts, write orders etc... NP's & CNS can work and function on their own license and speciality, again dependent on local pivilages.

Be safe,

R/R 911