Thursday, 5 November 2009

BTS Emergency Oxygen guidelines at Truro

Attended the Medical Unit's lunchtime meeting at Royal Cornwall Hospital for the first time today where they had a talk on the recent BTS Emergency Oxygen Guidelines from one of their Oxygen champions Dr Coutts. The presentation was largely based on the BTS's lecture for doctors on Emergency Oxygen use in adults with an emphasis on the practical changes that will occur in the Trust.

Oxygen therapy is still variable and suboptimal (1). The Trust will adopt saturation targets of 94 - 98% for most patients and 88 - 92% for those thought to be at risk of Type 2 Respiratory Failure. Oxygen is to be prescribed on treatment charts as this is apparently not commonly done - was routine in Bridgend when I was there. However, in Truro this is going to be with the use of stickers that make the saturation target, mode of delivery and flow rate explicit. There was an interesting discussion about how they are going to try and extend this practice across the PCT. Overall was a good informal reminder of Venturi masks, nasal canulae, reservoir bags, flow rates, oxygen dissociation curves (2) and the boundary disputes between paramedics, physicians and intensivists. Reminded of the editorial a few years ago in the BMJ (3).

I wanted to pop a question at the end to the junior docs such as "does anyone know a condition where patients present critically ill to A&E and where oxygen therapy is contraindicated? (answer = paraquat poisoning)" but thought better of it. Was my first time as a guest after all.

1. Hale KE, Gavin C, O'Driscoll BR. Audit of oxygen use in emergency ambulances and in a hospital emergency department. Emerg Med J. 2008;25(11):773-776. Available at: http://emj.bmj.com/cgi/content/abstract/25/11/773 [Accessed November 5, 2009].  
2. Thomson AJ, Drummond GB, Waring WS, Webb DJ, Maxwell SRJ. Effects of short-term isocapnic hyperoxia and hypoxia on cardiovascular function. J Appl Physiol. 2006;101(3):809-816. Available at: http://jap.physiology.org/cgi/content/abstract/101/3/809 [Accessed November 5, 2009].  
3. Thomson AJ, Webb DJ, Maxwell SRJ, Grant IS. Oxygen therapy in acute medical care. BMJ. 2002;324(7351):1406-1407. Available at: http://www.bmj.com [Accessed November 5, 2009]. 

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