O2 Sat 88%-90%, MD no action, opinions.

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A pt of mine had an 02 sat of 88-90% during my shift while on 5l oxymizer. The previous shift nurse stated she'd called the MD and alerted him to this but he decided to take no action... nurse state pt was CO2 retainer and this

was where "he lived". Would you over ride MD and put pt on more 02?

Specializes in Pediatrics, ER.

Nope, I definitely wouldn't up his O2 on my own if his breathing is run by hypoxic drive. 89-90% is not all that bad. Unless the pt is showing clear central signs of hypoxia I would do chest PT, have him turn and cough, and try repositioning...maybe give a neb if he needed it. Where I work we try to adjust the oxygen as a last resort, and do the above interventions first, plus suctioning for trached/vented pts.

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Specializes in Spinal Cord injuries, Emergency+EMS.

what was the patient's gases ? specifically their PCO2

were there any other subjective or objective signs of respiratory distress or compromise ?

if the patient is a known CO2 retainer and known to have poor sats 90% may well be their norm

SpO2 is a very limited tool for assessing respiratory status - it's great for tracking changes once you know someone's gasses , exam findings and history ...

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Specializes in Management, Emergency, Psych, Med Surg.

I would have to see the patient, assess him/her to really know the answer but as a general rule if you have a chronic COPD patient they usually do quite well (or as well as can be expected) with sats between 88-90%. Unless this patient was have new onset of additional symptoms like AMS, chest pain, etc I would think the patient would be fine where they are and I would not apply additional oxygen.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Respectfully,

If the patient is hypoxic, you can not use the hypoxic drive theory as a reason for "knocking out his respiratory drive".

I believe Dr. Kamen had his glory days in the 60s. For the past 25 years we have learned much more about the hypoxic drive theory. More physicians and textbooks now teach about the release of hypoxic pulmonary vasocontriction and V/Q mismatching. The release of the hypoxic pulmonary vasoconstriction when the nebulizer was given may have been what caused your patient to experience a sudden rise in PaCO2 and not the fact that someone was trying to get the patient's SpO2 from the low 80s.

Any Respiratory Therapist who with holds O2 from a patient as you described:

should have their license removed immediately or be demoted to tank jockey in the basement.

I only wish the respiratory therapist with held o2 some of the o2 being given........:confused:

If this patient this had a significant PaCO2 rise, he probably had a significant hypoxemia episode with pulmonary vasoconstriction. Some people do need ventilatory assistance but the alternative would be to see how long the cardiac, neuro and renal system can last while one theorizes about the "hypoxic drive". By your description, if nebulizers and O2 had been with held, this patient probably would have been a cardiac arrest and not just respiratory. Do not fear O2 when a patient is symptomatically in respiratory distress. If the patient goes apneic, it was probably inevitable.

And yes, it is possible to bag a patient who has an elevated PaCO2 level down but recognition of the respiratory distress, recovery time, adverse effects of hypoxemia and pulmonary vasculature constriction.

You are the first person in a long time that even knows who Jack Kamen is......... Even though his "glory days" was in the sixties.......don't disrespect his contributions to the profession. You seem extremely knowledgeable and I would love to have you as the therapist when I work........

What I was refering to is that we should always treat our patients first. Dr. Kamen retired from active anesthesia in the late early ninety's. I had the pleasure of working with him personally for many years. His quick wit, easy smile, and gentle demanor will be forever in my heart. He had an intense a desire to answer any question no matter how simple or how complex. He never tired of sharing his knowledge with whom ever wanted to learn. He took time to be sure all those around him learned something everyday.........a great and humble man!

I was directly refering to a class he taught the lowly new grads in 1979......." How too kill someone with good ABG's" It was a lesson not just in ABG's ABC's and 123"s it was a lecture on treating your patient and not the numbers or monitor, to check your patient first and in an emergency "TAKE YOUR OWN PULSE FIRST":lol2:. I 1991 that lecture was just as important when he gave it during classes for the hospital to open it's first open heart program.......check your patient,treat the patient not the monitor and in an emergency take your own pulse first! :idea: Valuable advice!

This particular patient was well known to me and probably should have gone to the unit. But when I was called to the patients bedside and found an obtunded barely breathing, well known, CO2 retainer (lived with PCO2 around 100) with respiratory therapy at the bedside 100% non-rebreather on fluch, 02 per NC @ 6lpm (still on) and "bleeding" continous 02 driven nebs under the non-rebreather mask and an explanation of......."He was short of breath when we started but the more oxygen we give him he just gets sleepier and sleepier....now we can't wake him up!":eek: NO! Really?:yeah: The ambu worked as it had too many times to count in the past......but that was a different problem.

You are, by your posts, and extremely experienced respiratory therapist (i can never remember the RRT initials stuff unless it is in front of me). The OP was talking about notifying the PCP and possibly circumventing the MD orders because of a certain "number". As nurses we need to make these decisions everyday based on all information and input. We are explaining the OP to look at the patient first, treat the patient, call the MD back, get more information before you treat a number just because it is a certain "number".

I always learn from your something from your posts.....:up:

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Critical Care RNs and those who work in Pulmonary units are also capable of learning respiratory stuff. Some of us have also been around awhile. I also sat in Dr. Henry Marriott's lectures way back when.

RTs do have the option of contacting their medical director if they do not agree with the attending physician. Then, a doctor to doctor discussion can occur to determine the right course of therapy. That is one way of getting a "pulmonary consult".

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
critical care rns and those who work in pulmonary units are also capable of learning respiratory stuff. ( they better it is their field of expertise ) some of us have also been around awhile. i also sat in dr. henry marriott's lectures way back when.

rts do have the option of contacting their medical director if they do not agree with the attending physician. then, a doctor to doctor discussion can occur to determine the right course of therapy. that is one way of getting a "pulmonary consult".

:-) there is always more that one way to skin a cat

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