Mike,
a common misconception about COPD and oxygen. The chest physicians shout
loudly about oxygen-driven respiration, but in the acute situation it is a
myth. COPD patients who get more hypoxic need extra o2 just like everyone
else. Many, many more COPD patients die of lack of o2 than too much of it
(in fact there is some debate as to whether hypoxic drive exists at all
outside of chest units!). If the worst happens and thay become
hypoventilatory then you can always switch the o2 off for a couple of
minutes to see if their resps pick up again, but I've NEVER seen this.
Even if your patient did have a history of COPD, you would still have been
completely correct. Unless the patient had a rising paco2 then the hospital
was wrong to give a 24% o2 mask. Dropping to 60% or even 35% may have been
justified depending on the clinical pricture until a very high or rising
paco2 could be ruled out with blood gases.
You'd be hard pressed to find an A+E consultant who disagreed with this.
(although we're about to find out!).
Dr Robbie Coull
Locum GP
DipIMC RCSEd
BASICS Immediate Care Doctor
ALS Instructor
email: [log in to unmask] website: http://www.coull.net
ps If you remember, I posted a similar comment on the prehospital list last
year regarding an ambulance crew removing my 100% o2 rx - someone passed
that message to ambulance HQ and I ended up in hot water (again!).
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