COPD & NRB your input please

[crb613, BSN, RN]

I had a pt come in the other night severe resp. distress. We had little hx on the pt at the time except COPDer, and he could not talk (working to breathe). He was diaphoretic, rr 30+ guppy breathing, tachy,lethargic. Sats with good wave form 70%. Lungs sounded like crap. EMS had him on 4l nc.

RT was there took him off oxygen to get room air ABG, then back on 4l. During this sats dropping rapidly down to 60% and they were not coming up....rr increasing along with hr.

I wanted to put him on a NRB, another nurse said no he's a retainer.....waht are you thinking??? I was a little upset with this.....my response was so we let him code & then do something? My thinking if you need oxygen you need oxygen.... treat what you see in front of you. His ABG ph 7.2, PCO2 60, HCO3 30.

Just wondering how you all would respond to a pt like this?

[dmc_rrt]

As an RT I would definetly put the pt. on the NRB. Actually it sounds like the pt needed BiPap more then anything. I have never seen a COPDer stop breathing from too much O2, and if it does you remove the O2, and soon the pt will start breathing again(according to theory).

[RRT_charlie]

I would have kept the pt on the NRB while drawing the gas, but I also would have been seriously considering putting the pt on Bipap. It sounds like this particular pt needed the PS for WOB - a NRB would have given them a higher O2 concentration but wouldn't have addressed their patient's labored breathing. I personally do not believe that you can knock out a COPD-ers hypoxic drive as I have yet to actually see it occur in any patient I have ever treated. If the pt needs O2, they need O2 and it should be given to them. If they have COPD then they should be watched carefully for any adverse reactions, but I would never hesitate to crank up the O2 on ANY patient if they needed it at that moment.