NREMT Paramedic Cognitive ExamAirway, Respiration & VentilationMedium
A 72-year-old male with a history of COPD is experiencing an acute exacerbation. He is alert and oriented, speaking in short sentences, and has diffuse wheezing bilaterally. His SpO2 is 90% on room air. Which of the following is the MOST appropriate oxygen therapy goal for this patient?
- ATitrate oxygen to relieve dyspnea, regardless of SpO2.
- BMaintain SpO2 between 90-94%.
- CAchieve SpO2 of 98-100%.
- DAdminister oxygen only if SpO2 drops below 88%.
Show answer & explanationAnswer & explanation
Correct answer: B. Maintain SpO2 between 90-94%.
For patients with COPD, excessive oxygen administration can suppress the hypoxic drive, leading to hypoventilation and CO2 retention. The goal is to provide just enough oxygen to maintain adequate oxygenation without causing respiratory depression. An SpO2 target of 90-94% is generally recommended for acute exacerbations of COPD.
Why the other options are wrong
- A. While relieving dyspnea is a goal, it must be balanced with maintaining appropriate SpO2 targets to avoid CO2 retention.
- C. Achieving an SpO2 of 98-100% can lead to hyperoxia and respiratory depression in COPD patients.
- D. Waiting until SpO2 drops below 88% is too late and risks significant hypoxemia.
Controlled Oxygen in COPD
In patients with COPD, the respiratory drive is often based on hypoxic stimulation. Administering too much oxygen can remove this drive, leading to hypoventilation and hypercapnia. Oxygen should be titrated to achieve a target SpO2 of 90-94%.
- COPD patients may rely on hypoxic drive for breathing.
- Excessive oxygen can cause CO2 narcosis.
- Target SpO2 for COPD exacerbation is 90-94%.
Memory trick: For COPD, keep oxygen in the 'safe zone,' don't let it drone.