Pulse ox and upgrading
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teedubbyaw
Forum Deputy Chief
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SpO2 does not dictate how emergent the call is. You have to look at the whole picture. Someone with sats in the 80's could be completely normal for them.
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Oxygen saturation is but one part of the puzzle. I've never based my decision to transport emergently or bring in an ALS provider simply upon a pulse oximetry reading all by itself.
DesertMedic66
Forum Troll
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There is no exact limit. A patient with 100% O2 sat may still be a critically ill patient while a patient with 90% may be stable.
Ewok Jerky
PA-C
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"Treat your patient not the number"
I'm not upgrading unless my patient requires an intervention I can't provide and medics are closer than the hospital.
I will upgrade to code 3 if they have chest pain, diaphoresis, diff breathing, RR <12 or >30, or poor skin signs. Or some other obviously bad thing.
Use your clinical judgement and go with your gut. Act in the best interest of your patient, if medics are far away just transport yourself.
I'm not upgrading unless my patient requires an intervention I can't provide and medics are closer than the hospital.
I will upgrade to code 3 if they have chest pain, diaphoresis, diff breathing, RR <12 or >30, or poor skin signs. Or some other obviously bad thing.
Use your clinical judgement and go with your gut. Act in the best interest of your patient, if medics are far away just transport yourself.
WildlandEMT89
Forum Lieutenant
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I treat pulse ox as a tool for assessing any interventions done.
We recently were dispatched code 3 for respiratory failure to an urgent care facility. Upon arrival we find the pt who is aox4 and speaking in complete and appropriate sentences. Pulse ox is found to be on the low side (86) but all other vitals found to be wnl. Pt states that she smokes approximately 5 cigarettes a day and came into the urgent care for unrelated pain due to a fall 2 weeks prior. Pt advised of findings and concerns but refuses transport and we clear from the scene.
For me to consider upgrading due to a pulse ox reading I would have to see a drastic change in readings in a quick period of time or a downward trend over time and be stumped as to what to do next.
We recently were dispatched code 3 for respiratory failure to an urgent care facility. Upon arrival we find the pt who is aox4 and speaking in complete and appropriate sentences. Pulse ox is found to be on the low side (86) but all other vitals found to be wnl. Pt states that she smokes approximately 5 cigarettes a day and came into the urgent care for unrelated pain due to a fall 2 weeks prior. Pt advised of findings and concerns but refuses transport and we clear from the scene.
For me to consider upgrading due to a pulse ox reading I would have to see a drastic change in readings in a quick period of time or a downward trend over time and be stumped as to what to do next.
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Rarely, rarely, rarely is risking you, your partner's, your patient's and everyone else who's on the road lives in the best interest of the patient.
I'm not going to parrot the other good advice given here.
I don't carry 50lbs of ALS gear for ****s and giggles.
Two words: clinical correlation.
Ewok Jerky
PA-C
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Not sure what your point is. Are you saying that BLS should not transport code 3 (only rarely, rarely, rarely) but rather wait for ALS if they think a patient is crumping?
Jason
Medic
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Ok ... so I'm just gonna go out on a limb and say my 2 cents on this matter ...
Maybe it's misunderstanding ... maybe it's training ...
There is nothing the Pulse Ox is gonna tell me that my basic EMT skill level assessment can't tell me more. It's not my ALS assessment, it's a BLS assessment. There is no piece of equipment, by itself, on my rig that tells me the Pt is in trouble. The Pulse Ox should never have become a standard of care. It's too easy to fool, too easy to get wrong numbers. Basic assessment rules over Pulse Ox any day of the week.
Bottom line - learn to do a good assessment and learn to trust your instinct and "gut".
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I suppose that may be true about the very earliest phases of patient assessment. You should be able to walk into someone's living room and within the first few seconds of the encounter judge their level of respiratory distress, which is a proxy for their gas-exchange status.
But I wouldn't go nearly as far as to say that "it shouldn't be the standard of care". In the big picture, the hemoglobin saturation is arguably one of the most important objective pieces of information. It's one of the biggest pieces of the overall objective-data-puzzle. Widespread use of pulse oximetry is considered by many to be the single most important contributor (among many) to the dramatically improved patient safety seen in anesthesia and critical care over the past few decades.
Unless you are getting an erroneous reading (which can be easily judged by the waveform), a low Sp02 is not something to ignore.
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double post
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Indeed it is, but the tool by itself isn't worth much. Clinical correlation and watching trend data is what's helping. I'm going to get very, very busy if I see a patient who isn't doing well and whose SpO2 trend is declining. If my patient has an SpO2 in the mid-high 80's, and that's stable, along with good mentation (and not lethargic), I'm going to not be too worried. The patient has likely adapted to the situation.
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I'm saying that rarely is any patient we see truly time critical and many ALS interventions have show absolutely no effect on morbidity and mortality.
Emergent transport hasn't shown an effect either except in a small patient population and is a high risk ordeal. Just because the patient has an "ALS" complaint shouldn't warrant a code 3 transport.
Point is emergent transport (and response) is widely overused both by BLS and ALS crews.
gonefishing
Forum Deputy Chief
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Treat the patient not the machine.
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I've said it a million times and I'll say it again. I don't lug around my ALS gear to disregard the quantitative and qualitative information it provides me.
Clinical correlation.
I cannot stand that saying. You're basically saying we should just drive empty ambulances since you're not going to listen to what your tools tell you.
gonefishing
Forum Deputy Chief
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No... not at all. I would go through the proper of checking the machinery on myself if the patient was obviously fine but a low saturation. Respiratory distress will show itself if you remember your basic signs and symptoms. My mother had pna last year. By testing her cap refill, watching her alright breathing and taking some lung sounds I didn't need a machine to tell me "oh hey shes sinking" I could see it. I than place a pulse ox on her and sure as apple pie she was at a sat of 86% yea cool tool but an assessment did just the same for me to know the issue. Didn't need a machine to do that. Helpful yes. BUT anyone could walk into a smoke filled room exit and maintain 100% on a ox but patient could say different. So I know you wouldn't go with the machine and say they were faking.lol
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Gonefishing, it's clear that you're hearing the words but not understanding the message. Yes, at some point we all get beaten into our head "treat the patient, not the monitor" but at some point, it's clear that you need to learn to clinically correlate findings from all your tools to what your physical assessment shows. I have seen patients with satting at 86% and they seem to be doing fine. I've seen patients satting 96% and are starting to circle the drain.
So, do you then not take vital signs? After all, those are "monitors" that could lie to you...
My hands, eyes, ears, stethoscope, EKG machine, glucometer, pulse oximeter... all those are tools that I use to assess my patient. You'd better believe that I'm not going to leave my equipment behind just because I think I can make a good field diagnosis without them. If I didn't need the stuff, things would be a whole lot easier because I wouldn't have to lug many pounds of extra equipment around just to look important...
So, do you then not take vital signs? After all, those are "monitors" that could lie to you...
My hands, eyes, ears, stethoscope, EKG machine, glucometer, pulse oximeter... all those are tools that I use to assess my patient. You'd better believe that I'm not going to leave my equipment behind just because I think I can make a good field diagnosis without them. If I didn't need the stuff, things would be a whole lot easier because I wouldn't have to lug many pounds of extra equipment around just to look important...
gonefishing
Forum Deputy Chief
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I didn't say anything about leaving equipment behind..... I did not ever say such a thing. What I am meaning to say is just don't treat the machine. YES the tools are necessary. I love them I use them. But what people need to ensure is that they are placing all the puzzle pieces together. Go with your gut and your signs and symptoms not just a machine. In my sentence the machine is included. I'm not anti machine or advancement in technology or a beleive in keeping it simple like the johnny and roy days. I think it was a simple misunderstanding. My example is most times you can tell a patient going down the drain by your signs and symptoms as well as with a basic assessment. Yes use the tools. Did not say ANYTHING about leaving them behind.