NREMT Paramedic Cognitive ExamAirway, Respiration & VentilationEasy
A 65-year-old male with a history of COPD is experiencing an acute exacerbation. He is alert and oriented, in moderate respiratory distress, and his SpO2 is 88% on room air. His respiratory rate is 24 breaths/min, and he has diffuse wheezing. What is the most appropriate initial oxygen delivery device and flow rate for this patient?
- ABag-valve-mask ventilation with supplemental oxygen.
- BVenturi mask at 24% FiO2.
- CNasal cannula at 2 L/min.
- DNon-rebreather mask at 15 L/min.
Show answer & explanationAnswer & explanation
Correct answer: B. Venturi mask at 24% FiO2.
For COPD patients experiencing an acute exacerbation, controlled oxygen therapy is crucial to prevent respiratory drive suppression. A Venturi mask at a precise low FiO2 (like 24%) is ideal for achieving target SpO2 levels (typically 88-92%) without over-oxygenation.
Why the other options are wrong
- A. The patient is alert, oriented, and breathing adequately (RR 24), so bag-valve-mask ventilation is unnecessary and inappropriate at this stage.
- C. While nasal cannula can deliver low flow, a Venturi mask provides more precise control over the FiO2, which is critical for COPD patients.
- D. A non-rebreather mask delivers high FiO2, which can suppress the hypoxic drive in COPD patients, leading to hypercapnia and respiratory arrest.
Controlled Oxygen in COPD
Administering oxygen to COPD patients at precise, low concentrations to achieve a target SpO2 (typically 88-92%) without suppressing their hypoxic respiratory drive.
- Hypoxic drive is primary respiratory stimulus in some COPD patients.
- Over-oxygenation can lead to hypercapnia and respiratory acidosis.
- Venturi masks are preferred for precise FiO2 delivery.
Memory trick: Oxygen: Right Dose, Right Patient, Right Time.