Recently I was asked to treat a patient who was admitted to hospital with an infective exacerbation of COPD (emphysema.) When I saw the patient, he had been in hospital for 4 days and his infection had cleared up. He had a non productive cough and his chest was clear. The main problem that he had was his oxygen saturation. This was maintained in the low 90's with one litre of oxygen via NP and hovered around the high 80's on RA. With ambulation the patient desaturated markedly and within 3 minutes of walking (approx 80m) his SpO2 was 79%. If I was by myself I would have not allowed his sats to drop so low however I was with my supervisor at the time so she instructed me to keep going. The patient was also getting quite frustrated as he wanted to go home and continue work and he couldn't understand why he wasn't being discharged when he felt like normal.
I was slightly anxious in allowing a patient to desat by so much and I was forced to explain to the patient why we could not let him go home with such a low oxygen saturation. I had to explain that is heart would be working far too hard with oxygen levels that low, but also had to keep in mind that he felt as though it was always that low. This made me feel uncomfortable and I could only suggest to the patient that hopefully his oxygen levels would continue to increase as his body bought the infection.
When the patient's sats dropped to 79% he only felt slightly short of breath which made me wonder how you would know if a patient was desaturating by that much if you weren't in a situation where you had an oximeter on hand.
This situation has made me realise how easy it is for a patient to desaturate after having a lung infection and I will definitely ere on the side of caution when dealing with these patients in the future.
1 comment:
I guess with patients that suffer from COPD, their pre-admission resting SpO2 would be relatively lower than normal. And because of the infective exacerbation, their SpO2 would drop even further. With a patient like this, their sats do drop but sometimes they hardly feel it! Like your patient, his sats were at 79% but all he felt was slightly SOB. SOB is a subjective feeling and different patients feel differently. I once had a patient whose sats dropped to low 70s and he also felt slightly SOB!
Have you tried implementing the SOB management techniques and see how your patient reacts? If his sats are able to come back up, i believe pacing of activities would be really good for the patient. I guess if you do not have an oximeter on hand, you really have to depend on the patient's feedback to you. (eg. SOB, if the patient stops talking, colour etc.) At this point, I suppose the only thing you can do is slowly rehab the patient to be able to walk a particular distance without desating as much? Or monitor the time it takes for the patient's sats to return to pre-exercise state. Hope my suggestions help! :)
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