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Emergency oxygen therapy for the breathless patient. Guidelines prepared by North West Oxygen Group
  1. R Murphy1,
  2. K Mackway-Jones1,
  3. I Sammy2,
  4. P Driscoll2,
  5. A Gray3,
  6. R O'Driscoll4,
  7. J O'Reilly5,
  8. R Niven6,
  9. A Bentley7,
  10. G Brear8,
  11. R Kishen9
  1. 1Department of Emergency Medicine, Manchester Royal Infirmary
  2. 2Department of Emergency Medicine, Hope Hospital, Salford
  3. 3Department of Emergency Medicine, Stepping Hill Hospital, Stockport
  4. 4Department of Chest Medicine, Hope Hospital, Salford
  5. 5Department of Chest Medicine, Victoria Hospital, Blackpool
  6. 6Department of Chest Medicine, Wythenshawe Hospital, Manchester
  7. 7Department of Intensive Care Medicine, North Manchester General Hospital
  8. 8Department of Intensive Care Medicine, Wythenshawe Hospital, Manchester
  9. 9Department of Intensive Care Medicine, Hope Hospital, Salford
  1. Correspondence to: Dr O'Driscoll (rodriscoll{at}hope.srht.nwest.nhs.uk)

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Based on a systematic review of the scientific literature, the North West Oxygen Group have developed guidelines for oxygen therapy for patients who present with acute breathlessness. The above emergency medicine physicians, chest physicians and intensive care physicians have gained approval from their regional societies to have this document accepted as the agreed regional guidelines for the use of oxygen in the immediate care of breathless patients in the North West of England. Flow charts are also currently being developed, based on these guidelines, for use by ambulance and emergency department staff in the area.

It is recognised that the present use of oxygen across these specialties is inconsistent. This protocol will help us to deliver standardised oxygen therapy to breathless patients by paramedics, doctors and nurses. This will also improve the consistency of medical training across these disciplines in the North West.

Introduction

It is crucial to provide optimal oxygen therapy while the acutely breathless patient is being transferred to hospital, assessed in the emergency department and treated for their disease. For most such patients, the main concern is to give sufficient oxygen to support their needs. The major risk is giving too little oxygen (hypoxia). Insufficient oxygen therapy can lead to cardiac arrhythmias, tissue damage, renal damage and, ultimately, cerebral damage. However, excessive oxygen therapy can be dangerous for some patients with respiratory failure.

Problems faced by ambulance staff

Patients who present acutely with breathlessness will have varying requirements for oxygen therapy depending on the underlying cause of their symptoms. Most acutely breathless patients will have conditions such as asthma, heart failure, pneumonia, pleural effusions, pulmonary embolism or pneumothorax and some may be victims of major trauma. These patients require high concentration oxygen therapy. For most of these patients, 40%–60% oxygen will be sufficient to maintain satisfactory oxygenation (for example, 4–10 l/min from a …

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