Sorry but this case doesn't make sense. If you're delivering oxygen
at 24% through a venturi mask, you need 3L/min O2. Therefore 2L/min
is -well virtually the air which we breath. You forgot to give us the
vital info here-what was the bicarbonate? Was this patient a chronic
CO2 retainer (high bicarb)-would be very suprising in a lifelong
non-smoker? The CO2 indicates hypoventilation but crucially it can be
for any number of reasons, not just a hypoxic drive. Are you sure
that this patient hadn't actually suffered from a (?transient) cardiac
or neurological event
Best wishes
Francis andrews
---------------- reply ----------------
> I know we've visited this a few times before, but I had a classic
the
> other night:
> 80 year old non-specifically unwell referred by GP (I am a medic at
the
> moment) bit of a non-productive cough lifelong non-smoker. When s/b
HO
> in A&E the relatives were saying that her speech had gone all funny
and
> she had become very sleepy while the ambulance crew were packaging
her
> within minutes of starting O2. HO asked me to see her -- very
drowsy,
> some appropriate responses to questions but disorientated, resps 10
sats
> mid 90s, puffing away on 2 litres only.
>
> ABGs: pO2 16 pCO2 14 pH about 7.2
>
> took the O2 off and 15 minutes later, fully alert and orientated
> chatting away. I'd never seen narcosis come on or go off that
quickly.
>
> Re-inforces the "100% O2 isn't right for everyone" argument,
> particularly if transport times are long -- although not in this
case,
> notwithstanding those who are retaining but you have to give O2
anyway
> before they die from hypoxia (had one of those last night too).
> --
> Sam Waddy
> Medical SHO
>
Francis Andrews FFAEM
Lecturer in Intensive Care Medicine
Department of Medicine
University of Liverpool
Daulby St
L693GA
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