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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