This is an ongoing problem locally and our Respiratory Physicians would
adhere to the views of your second speaker. The problem was discussed at a
regional Conference at Haydock (which I couldn't attend) and I believe the
consensus was high concentration oxygen initially with a reduction as more
clinical information
becomes available in A&E with ABG analysis, CXR etc.
I would agree with the latter. However I believe all staff tend to forget
that oxygen has a positive and a negative side. Patients need to be reviewed
carefully. There is nothing more infuriating for respiratory physicians to
see an ABG result with no documentation as to the concentration of oxygen
given at the time!
We had a patient (no history of COPD) at Kendal only last month who was
commenced on high concentration oxygen, this was continued on the ward
despite the patient becoming drowsy. The problem was only diagnosed when the
patient was reviewed by a doctor later that day. I can think of many such
cases over the years, but I can't remember any deaths in A&E. But if we went
to the opposite extreme we would probably cause even more harm. I wonder if
your second speaker was a medic on the front line?
Perhaps if Oxygen had to be prescribed we (me included) would all be more
careful in reassessing patients.
I think this argument will continue.
Regards,
Ray McGlone
A&E
Lancaster
----- Original Message -----
From: Bill Bailey <[log in to unmask]>
To: a&e group <[log in to unmask]>
Sent: Wednesday, July 12, 2000 3:09 AM
Subject: Oxygen administration in COPD
> I attended an emergency medicine conference in London earlier this year
> where two Professors of Respiratory Medicine [one from London, the other
> from Liverpool] gave lectures addressing the early management of COPD.
> Unfortunately, but amusingly, the second speaker did not hear the first
and
> completely contradicted him re what FiO2 should initially be used
> [pre-hospital and in A&E]when treating patients with respiratory distress
> and a history of COPD. In a nutshell the 1st speaker advocated as much
> oxygen as possible initially with a reduction as more clinical information
> became available in A&E with ABG analysis, CXR etc. The 2nd speaker became
> very agitated when this was suggested after his lecture and claimed such
> treatment kills more elderly patients with COPD via hypercarbia and
acidosis
> than the Bubonic Plague did in the Middle Ages.
>
> Any thoughts from you chaps who manage this problem for real on a regular
> basis?
>
> Bill Bailey
> A&E Consultant, Nth Derbyshire
>
>
>
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