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Mike DEFINITELY high flow. You were in the right. Remember that patients frequently die from hypoxia, but not from CO2 retention. In your case myocardium needs oxygen and COPD patients frequently have co-existing myocardial disease. It is easily possible to keep patients alive on high flow O2 but with a poor repiratory effort (and high CO2)-much more difficult the other way round. On ICU, we frequently ventilate COPD and asthma patients with a very low frequency and tidal volume to avoid air trapping but with a high FiO2- CO2 levels often become extremely high but the patients remain oxygenated and survives. I frequently get referrals from the wards and A&E to assess COPD patients to see if they are suitable for ICU. About 50% get better there and then because I turn up the oxygen to cure their hypoxia and hence respiratory muscle hypoxia etc, induced by 24%FiO2! In virtually all cases, there has been no demonstration that the patient has a hypoxic drive. It is true that a SMALL minority of COPD patients have a hypoxic drive, but in my view it is safer to oxygenate them properly first and keep an eye on their clinical condition and adjust according to gases etc + there is always non-invasive ventilation to help them. This has been commented on fairly recently in the letters page of the BMJ by a number of intensive care docs who are fed up at being referred hypoxic patients from people who ought to know better. Ask any intensivist if you don't believe me! Cheers Francis Andrews FFAEM Lecturer in intensve care medicine/hon. Spr in ICU & A&E University of Liverpool/Whiston hospital [log in to unmask] On Wed, 29 Mar 2000 01:14:03 +0100 Michael Bjarkoy <[log in to unmask]> wrote: > My protocol in the ambulance service states that I should give an FiO2 of > 0.98 to acute COPD. > I recently had a patient on my bus who had a high lateral infarct with CCF - > ONF very poor. NO evidence of COPD. > > At the receiving hospital I was asked to take the patient off high flow O2 > and reduce to 24% for COPD even though there was no PMH of this. This has > bothered me ever since as there was no obvious indication of COPD at the > time. > The questions I must ask - as I must be assume ignorance are - > > How does COPD present as an acute and new onset as opposed to CCF with AMI. > > All the paramedic manuals state COPD in an emergent situation should be > given high flow O2. Is there a change of thinking here or are the ambulance > services ahead of AEU. > > I thought I was right and unless you chaps can produce evidence to the > contrary I shall assume the evidence I have to hand is correct and the doc > wrong. > > High flow or not - that is the question. > > Mike Bjarkoy > Paramedic > Sussex > ---------------------- [log in to unmask] %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%