Many of the arguments around this issue come about because AE and respiratory
physicians think they are talking about the same thing when they are not. This
came out at the Haydock meeting referred to by Ray McGlone.
We are faced with a breathless patient, who may or may not have COPD, and even
if they do, they may be breathless for a reason other than a COPD exacerbation.
Respiratory physicians talk about patients with exacerbations of COPD and type
2 respiratory failure.
Generaly speaking we agree on the management of the second group of patients.
Keep Sa02 > 92% with 02 and check, then recheck blood gases to ensure that the
patient is not retaining C02.
There is a working group in the North West involving respiratory physicians,
Emergency physicians, ITU and others looking at the issue of O2 therapy. It
appears that there will be general agreement to start with O2 in all patients
and then monitor the effect. However, I am not a member of the group and must
wait for the final outcome.
Interestingly, has anyone ever thought of using capnography to monitor rise
/ fall of CO2 in these patients? It would be less invasive than serial ABG's
Simon Carley
SpR in Emergency Medicine
Manchester Royal Infirmary
Manchester
[log in to unmask]
>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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