COPD review

You know it really depends on the patient. I knew a great anesthesia doctor Dr Jack Kamen and when I we new to nursing/ICU he gave us a lecture. How to kill a patient with good ABGs. It emphasizes that COPD patient can live with horrible abgs and feel just fine. Treat the patient not the numbers. I had a COPD patient...years ago. "Sadie" was essentially homeless and ABGs that were worse than those you would find on a corpse....yet she lived. She would come in all the time with her O2 tubing melted because she would smoke with the O2 on and tell us it was spontaneous combustion.

When Sadie would come in in respiratory distress we would give her O2 to try to get her to base line......however high the O2 would need to go.....but we were very careful to watch for signs of CO2 narcosis and decreased drive/lock and would intubate her if necessary until she made herself a DNR. If they are going to die with out O2 and they are a code then you give them O2 you just need to be aware it is very dangerous.

Patients with COPD have a stimulus for respiration which is driven by the decrease in blood oxygenation, rather than an increase in CO₂ levels as seen in a patient with no respiratory problems.

Administration of a high amount of oxygen (over 2 L/ min) to a COPD patient causes in increased oxygenation in the blood, but blocks their breathing stimulus (respiratory drive). While the higher level of oxygen helps the patient very briefly in the short term (by bringing up their O₂ levels), it causes the patient to breathe at a slower rate, causing a buildup of CO₂ in the blood stream. Add this buildup to the already increased CO₂ level that the patient's body is already accustomed to and the patient will very rapidly develop carbon dioxide narcosis (CO₂ toxicity) which will ultimately lead to the patient's death.

Hypoventilation syndromes

Medscape: Medscape Access medscape requires registration but it is free...it's got great resources. I can't get rifd of the stupid highlighting...sorry