May 31st, 2010 | 
Author: Teaching the 5th years in the final gasp of their medical school career, the APART course last week ran them through some scenarios of acutely unwell patients. This was quite literally their last two hours of medical school before starting work in August and I was surprised at the sea of blank faces when they were faced with a COPD patient in type two respiratory failure. The progressive (simulated) decline of the patient (accompanied by my now legendary impressions of “elderly confused woman” and “obstructed airway”) did little to trigger the request for non invasive ventilation. Comments like “ask ITU to keep an eye on them” did little to quell the rising panic in my little respiratory educationalist heart. Once the topic of NIV was broached there remained an air of mild confusion and the whiff of misunderstood acronyms in the air. What is BiPAP, CPAP, NIPPV? Can’t you just tube them all? I find myself relieved that the new and improved respiratory teaching for the second years will go some way to exposing our students to this most oft used and useful of therapies, but what of the students in the more senior years? DundeeChest 3.0 to the rescue….? When I find some useful web resources in this area I will post them, but I have to admit I’ve come up short so far.
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You’ve noted an on going problem.
I was approached by a pretty decent FY2 last week – he asked me what the ‘new’ oxygen guideline says about those patients with Acute Type 2 Respiratory Failure. Aha, thinks I, at least he’s noted the difference between acute and chronic T2RF. I tell him the answer (SaO2 94 – 98 %), and he looks puzzled. Then he says – but only 30 % oxygen, yeah?
I feel like I am the only person teaching correct oxygen prescription to the whole of the medical school, and then the hospital too. I am about to give the 2nd year revision lectures, and they will ask me, again, to explain the difference between type 1 and type 2 respiratory failure, and I will say, again, that ‘hypoxic drive’ does not alone explain why patients with chronic type 2 respiratory failure retain CO2 when given too much oxygen. Sigh.
We are not helped in our quest by anaesthetists *still* sticking to the “hypoxia bad, oxygen good, man make fire, ugg ugg” dogma from 10 years ago.
I will make more stuff for the site, and try to explain COPD to students once more, and keep chipping away. I am going to try to put a 4th year student to gainful employ writing a section of the site, concentrating on the management of oxygen, with particular reference to chronic type 2 respiratory failure.
And can we stop calling it BIPAP? It’s NIV forchrissakes.