Hi Michael
Some COPD patients do not do well on high flow oxygen as they then have no
hypoxic drive. It is difficult to give different advice for different types
of respiratory distress so in Essex we are working with the local
respiratory physicians in Southend to run a pilot study on 24% oxygen
administration to patients with COPD. So that the protocol os foolproof(?)
we are only giving this lower flow to patients who have a card from the OPD
stating their need and who have been given the appropriate mask to carry for
their personal use. I will let the list know how we get on as other
respiratory physicians wish us to then extend the protocol county wide.
Sticking to the principle of doing the most good for the most people, I fell
the 100% prpotocol is fine for nearlly everyone and most COPD patients
tolerate 100% for a short while. It is the longer journeys whiich promote
the highest risk.
I am sure you were right to give 100% to your patient. COPD by definitiion
is long standing and not of sudden onset so you would not be expected to
make the diagnosis in what you see as a "new" patient. Have confidence in
your own abilities - Panorama was wrong! I sus pect this was a hospital, not
paramedic, error
Best wishes, Judith
DrJudith Fisher MBBS FRCGP FFAEM Dip IMC
Medical Director, Essex AmbulanceService NHS Trust
-----Original Message-----
From: Michael Bjarkoy <[log in to unmask]>
To: acad-ae-med <[log in to unmask]>
Date: 29 March 2000 00:16
Subject: COPD and Oxygen
>My protocol in the ambulance service states that I should give an FiO2 of
>0.98 to acute COPD.
>I recently had a patient on my bus who had a high lateral infarct with
CCF -
>ONF very poor. NO evidence of COPD.
>
>At the receiving hospital I was asked to take the patient off high flow O2
>and reduce to 24% for COPD even though there was no PMH of this. This has
>bothered me ever since as there was no obvious indication of COPD at the
>time.
>The questions I must ask - as I must be assume ignorance are -
>
>How does COPD present as an acute and new onset as opposed to CCF with AMI.
>
>All the paramedic manuals state COPD in an emergent situation should be
>given high flow O2. Is there a change of thinking here or are the ambulance
>services ahead of AEU.
>
>I thought I was right and unless you chaps can produce evidence to the
>contrary I shall assume the evidence I have to hand is correct and the doc
>wrong.
>
>High flow or not - that is the question.
>
>Mike Bjarkoy
>Paramedic
>Sussex
>
>
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