Some are more sensitive than others.

Over the years of being a Respiratory Therapist I have learned a few different schools of though on the use of oxygen and how effective it is at different levels.

It has varied from:

• 100% Nonrebreather to in reality a 70-80% nonrebreather. A lot of nurses actually believe it is really 100% oxygen the NRB is giving.
• OWL protocol, or Oxygen With Love. This actually really seemed to work and what it was used for was to decrease the occurrences of retinal detachment in babies in the NICU. The protol was to keep the SPO2 level between 88-92%. We all know that high levels of oxygen can cause retinal detachment in infants, well this protocol actually worked, it decreased the amount of infant that needed eye surgery due retinal detachment from around 60% down to below 20% at the hospital I worked at. So did it work, I think so.
• You need a bubbler with oxygen. No you don't, not always. I do give them our for levels over 4 lpm on the nasal cannula IF they are at that level for awhile, or they are getting bloody or burning nares.
• All Post-Op patient need 2lpm of O2 for 12hrs after surgery. I think not.
• Anything under 2 lpm with a Nasal Cannula is a worthless on a adult.

That last one is a area that I'm dealing with right now. All of the other hospitals that I have worked for we were in the school of thought that under 2 lpm, you might as well just take them off because it doesn't do anything for that patient.

For some reason that has been true so far for me and my patients, until I started here at my current hospital. I recently had 3 different patient who I just couldn't wean off of oxygen. They were a 15 month old, a 60 year old and a 83 year old and they were all on the under 2 lpm levels of oxygen, which seemed to be the kicker.

Now that 15 month old I do understand that pediatric patients do respond to lower levels of oxygen flow, which is why they make a low flow oxygen flowmeter which goes from 0.1 to 1 lpm. This patient had a possible pneumonia but great sounding lung sounds after a day, but we could not get this child off of the 0.1-0.2 lpm of oxygen. She would drop to the mid to low 80's without it and as soon as I put it back on, poof back up to the high 90's.

Then the 60 year old I had. This person was a long term smoker, probably had COPD also so I would assume that this person lived in the low 90s to the high 80s. But what was interesting is that on RA this patient would drop down to 80% so we would put 0.5 lpm O2 on and the sats would jump back up to 97% right away. Seriously 1/2 lpm and the spo2 would jump that high. I was amazed. I had always learned that under 2 lpm was a waste of oxygen and equipment.

Now the last patient, my 83 year old was the same way. I was doing my oxygen rounds and I checked her spo2 on 1 lpm and she was 99% on the 1 liter. Great I though, I can take her off the oxygen, which I did. I then came back in a hour just to make sure that the sats were fine and wow was I shocked. 78% on RA!!!! I'm thinking, "Really no kidding, that 1 liter made that much difference with her!!!". Well it did, I put her back on the 1 liter of O2 and BoooYahhh, it shot right up to 97%. Amazing.

This was in the same night, all three of them had their oxygen issues. This night right here disapproved the idea to me that anything under 2 liters per minute of oxygen is worthless in adults, I was a skeptic but now I think I might be a believer. Even most of the books say a nasal cannula is set between 2-6 lpm and 24-36%. Now 1/2 lpm is 23% according to the formula:

21% + (oxygen liters per minute *3) = fio2.

That there is under the book definition of the nasal cannula, but it seems to do some good. Oh well as long as they are not dying on me and it's that 1 lpm that is keeping them from doing so, I will keep using the lower levels now as needed.

if anyone has any information or web sites about the lower levels of oxygen on adults I would be very interesting in that information, because like I said I have always heard it worthless under 2 lpm, but apparently some patients are more sensitive than others.

Drive on RT's and thanks for reading.

Here's you card....Duhh

Ring Ring (RT Department Phone ringing)

Me: Respiratory Therapy, can I help you?

Nurse: I have a patient who wants to take his MDI, he has 2 in his med cabinet but only had orders for one of them but he wants the other, can I give it to him?

Me: What is the order for?

Nurse: Albuterol 2 puff, may take on own.

Me: What is the name of the other mdi medication he has?

Nurse: Ventolin.

Me: (Laughing to self) Ok Ventolin is albuterol, it's the a commercial name of albuterol.

Nurse: Really, I've never heard of it.

Me: Yea it's like how acetaminophen is the same a Tylenol, or ibuprofen is the same as Motrin only cheaper.

Nurse: Ok I got it, so which one can I give him?

Me: (Duh look no face) Which ever one he wants.


Someday people will understand.

High off Inhalers?

I ran across a article in Science Daily that is talking about teens misusing inhalers (MDI's) to get a buzz or get high off of them.

"Asthma inhaler misuse is prevalent in the adolescent population, particularly among antisocial teens, US study findings indicate."

I find this interesting because I'm wondering how many puffs off of a MDI do they have to do before the feel any effects of being high?

There was a study conducted to get an idea of how prevalent this actually is and the results were kind of surprising:

"Brian Perron (University of Michigan, Ann Arbor) and Matthew Howard (University of North Carolina at Chapel Hill) conducted a cross-sectional survey with face-to-face interviews assessing substance use, psychiatric symptoms, and antisocial behaviors among 723 adolescents in residential care. Over 26% (193) of adolescents were diagnosed with asthma, 91.2% of whom had received a prescription for an inhaler. Almost a quarter of the 373 adolescents who had used a prescribed or nonprescribed inhaler reported using an inhaler to get high."

Is this like any other inhalant that kids use to get high, is it like huffing gasoline, inhaling paint thinner? You would think that there would be a cheaper way to get this type of high, but I guess if insurances is paying for it or you are from a lesser well off family and you have a medical card, it probably is pretty low cost for the kids who do this.

Reading later in the article is shows what effects misuse of the inhaler can cause:

"Inhaler misusers were significantly more likely than asthma inhaler users to report euphoria, memory problems, slurred speech, blurred vision, confusion, dizziness, and a variety of other acute reactions to asthma inhaler use."

Pretty interesting to see how people will look to anywhere to find a way to get high, and with inhalers I'm sure these kids are thinking that this is a lot safer to use like this instead of other inhalants like gas and paint thinner. Wow what is this world coming to, are we now going to start have MDI seekers coming into the ER as well as the regular drug seekers? I'm doubt that would happen as this I couldn't see becoming very popular, but on the other hand you can never fully tell what is going to happen.

As you giving that MDI and spacer instruct to a person who you didn't think really needed that neb you just did on them, they might just be a one of those MDI get High people.