Thursday, June 15, 2006
Oxygen & COPD
For those of you who couldn't make it to that recent inservice, I thought I would post a few highlights that I found particularly useful.
Your Colleague,
Christopher. ¶ 4:05 PM
- Flowmeters: read the CENTER of the ball; i.e., the ball's horizontal diameter should intersect the tick-marks of the meter.
- If a pt's SpO2 drops or flow rate demands increase beyond previously prescribed parameters, then an MD should be notified, since pathology may underly.
- Nasal cannula on a mouth-breather gives adequate O2, as long as nares are patent, & SpO2 is appropriate.
- Approximate FIO2 levels (q1L=approx. 4% addn'l above RA)
- 1 lpm: 24%
- 2 lpm: 28%
- 3 lpm: 32%
- 4 lpm: 36%
- 5 lpm: 40%
- 6 lpm: 44%
- Ventimasks:
- don't cover air entrainment ports on adaptors (too much FIO2)
- don't use with humidification (too little FIO2)
- Pursed Lip Breathing:
- insp./exp. ratio of at least 1:2 (the longer exp. = the better O2 exchange)
- Hypoxic Drive Review:
- small % of COPD pts actually respire perforce of Hypoxic Drive
- thus, your patient could benefit from more O2
- If in doubt, get an ABG:
- If CO2 chronically continues to rise (>60mmHg), then consider Hypoxic Driver
- Then, only low PO2 levels (<55-60mmhg)>
- But the actual Hypoxic Drive occurs ONLY in pts who are BOTH hypoxic AND hypercarbic--("the 50/50 club")
- At this point low O2 flows (1-2 lpm) and careful monitoring are recommended.
- Qualifying for home O2: Pulse Oximetry must be done NO SOONER THAN 2 DAYS BEFORE DISCHARGE.
Your Colleague,
Christopher. ¶ 4:05 PM
