NREMT Paramedic Cognitive ExamAirway, Respiration & VentilationMedium
A 72-year-old female with a history of COPD presents with increasing shortness of breath over the past 24 hours. She is alert but anxious, tripodding, and using accessory muscles to breathe. Her respiratory rate is 28 breaths per minute, SpO2 90% on 2 L/min nasal cannula, and she has diminished breath sounds with expiratory wheezes. What is the most appropriate initial oxygen delivery device for this patient?
- AVenturi mask at 28% FiO2
- BNasal cannula at 4 L/min
- CBag-valve-mask (BVM) with reservoir at 15 L/min
- DNon-rebreather mask at 15 L/min
Show answer & explanationAnswer & explanation
Correct answer: A. Venturi mask at 28% FiO2
For a COPD patient in respiratory distress, it's crucial to provide controlled oxygen to avoid suppressing their hypoxic drive. A Venturi mask is ideal as it delivers a precise FiO2. Starting with a moderate FiO2 like 28% allows for titration based on the patient's SpO2 and clinical response, while preventing excessive oxygen administration.
Why the other options are wrong
- B. Nasal cannula at 4 L/min might not be sufficient for a patient in respiratory distress with an SpO2 of 90% on 2 L/min, and still lacks precise FiO2 control.
- C. BVM is for patients with inadequate ventilations or apnea, not for a spontaneously breathing patient who is alert and anxious.
- D. A non-rebreather mask delivers high FiO2 (up to 90-100%) which can be detrimental to COPD patients who rely on hypoxic drive.
Controlled Oxygen for COPD
Administering oxygen to patients with Chronic Obstructive Pulmonary Disease (COPD) requires careful titration to avoid suppressing their hypoxic drive, which can lead to hypoventilation and CO2 retention. A Venturi mask is often preferred for its ability to deliver precise concentrations of oxygen.
- COPD patients may rely on hypoxic drive to breathe.
- Excessive oxygen can abolish hypoxic drive, leading to hypoventilation.
- Target SpO2 for COPD is typically 88-92%.
Memory trick: Venturi's Very Controlled Oxygen Flow