I agree with your Mcg when you suggest that reevalation is the key - we
teach our sho's to chase the abg's every 15 mins and aim to keep the pH>7.26
with oxygen titration what do others do

----- Original Message -----
From: mcglonerg <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, July 11, 2000 7:59 PM
Subject: Re: Oxygen administration in COPD


> 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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