Hepinghand
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I am just wondering what is everyones feelings on pulse ox's are they good bad and how accurate are they?I have my own opinion but wanted to hear from the forum to see what your opinion is on this subject.
Pulse Ox
- Thread starter Hepinghand
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NomadicMedic
I know a guy who knows a guy.
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Not totally useless, but close to it. 
Certainly not anything diagnostic or a critical need.
Certainly not anything diagnostic or a critical need.I view pulse-ox's as a tool to assist in the confirmation of things we should already be able to assess by looking at our patient, and as a tool to be able to alert us to potential changes in pt. status while performing other tasks.
The accuracy of pulse-ox's is often called into question. Readings can be artificially high (i.e. cases of CO poisoning) or artificially low (poor peripheral circulation). However, in the vast majority of pt's - the pulse-ox's usually can confirm the validity of findings uncovered via our assessment.
I think pulse-ox's have a place and can be potentially useful in alerting us to sudden changes in pt. status (i.e. if the pt. begins to deteriorate); however, as the old adage goes - treat the pt, not the monitor.
The accuracy of pulse-ox's is often called into question. Readings can be artificially high (i.e. cases of CO poisoning) or artificially low (poor peripheral circulation). However, in the vast majority of pt's - the pulse-ox's usually can confirm the validity of findings uncovered via our assessment.
I think pulse-ox's have a place and can be potentially useful in alerting us to sudden changes in pt. status (i.e. if the pt. begins to deteriorate); however, as the old adage goes - treat the pt, not the monitor.
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JPINFV
Gadfly
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An important piece of diagnostic and monitoring equipment where, unfortunately, many who use them in EMS do not understand the limitations of the device and how to integrate the information into a clinical impression of the patient. If you're administering oxygen, there's no reason to not have education, training, and access to one. It's like giving adenosine without a cardiac monitor.
NomadicMedic
I know a guy who knows a guy.
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The only time I NEED a quantified pulse ox is when I intubate a patient and I have to document saturation levels during the procedure. In most other cases, I use capnography as a more reliable indicator of appropriate ventilation.
mycrofft
Still crazy but elsewhere
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Eh.
They are prone to as many problems as any other versatile diagnostic devices such as stethoscope. However, if it makes beeps, is red andy lit up and costs money to run, it demands attention (away from the pt), so on the whole and especially in moving environments, I am not impressed.
Don't even start with the pulse rate estimators attached.
PS: when I first started with EMTLIFE I said that and had my head sawed off. Ha HA HAH.
They are prone to as many problems as any other versatile diagnostic devices such as stethoscope. However, if it makes beeps, is red andy lit up and costs money to run, it demands attention (away from the pt), so on the whole and especially in moving environments, I am not impressed.
Don't even start with the pulse rate estimators attached.
PS: when I first started with EMTLIFE I said that and had my head sawed off. Ha HA HAH.
JPINFV
Gadfly
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To be fair, isn't the pulse rate part of a pulse ox supposed to be for making sure that the pulse ox is getting an appropriate reading instead of using it to monitor the patient's pulse?
mycrofft
Still crazy but elsewhere
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Yeah
It's like putting a stopwatch on your calculator, just because they can and there's a mantissa available. Showoffs.
It's like putting a stopwatch on your calculator, just because they can and there's a mantissa available. Showoffs.
+1
There's a reason you find it in every single OR, ED, and ICU room. It is a standard and useful vital sign, taken in context.
MSDeltaFlt
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Well I have very bad eyesight and it only aids in my assessment. However, I do use it like Orthopedic surgeons use them on their post op surgical pts. I'll compare injured to uninjured side then leave probe on injured side to monitor. Not unlike monitoring a cardiac pt in V1 or V6.
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As mentioned, it is an adjunct to a thorough assessment. A pulse ox is not likely going to be what tells me that a patient is in respiratory distress, but it will confirm an assessment that shows this.
It is useful in the IFT realm to throw the finger clip on someone that wants to sleep for the duration of the transport so I do not have to wake them up to get a pulse every so often, as long as the pulse is relatively close to the palpated baseline that I started with.
It's greatest purpose however, is to prevent overzealous and substandard EMTs from placing patients on 02 that just don't need it. If the patient is clearly having no difficulty breathing but my partner wants to put them on 02, you know "just in case it helps the pain," I'll show them the pulse ox reading and they will usually back off.
It is useful in the IFT realm to throw the finger clip on someone that wants to sleep for the duration of the transport so I do not have to wake them up to get a pulse every so often, as long as the pulse is relatively close to the palpated baseline that I started with.
It's greatest purpose however, is to prevent overzealous and substandard EMTs from placing patients on 02 that just don't need it. If the patient is clearly having no difficulty breathing but my partner wants to put them on 02, you know "just in case it helps the pain," I'll show them the pulse ox reading and they will usually back off.
18G
Paramedic
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Pulse oximetry carries a lot of value when incorporated in your assessment correctly.
mycrofft
Still crazy but elsewhere
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Parse that?
Sounds good, and it looks good on the contact report. As long as the pt comes out OK, then it is OK. Other means of eval have come and gone. Sometimes not because the tool is bad but the human factor is not up to it, or the device doesn't work well in the field.
Anecdote: in an a preliminary effort to see if increased respiratory effort in chemical warfare gear caused lowered blood oxygen levels, I put a person in a double N95 mask (about the same resistance as the MCUP2 or a leaky M17 mask) and had him do jumping jacks until he was very short of breath. Didn't take long. Pulse ox still said he was fine, but in truth he was building enough CO2 up to cause the sensation of breathlessness (a primary symptom of low level CO2 poisoning is an increased respiratory drive, same as ammonia). If he had had underlying coronary disease this could have been serious.
Lots of confounders to pulse-ox, especially in the venues of cold extremities, nail polish, poor distal circ, and damaged probes.
Sounds good, and it looks good on the contact report. As long as the pt comes out OK, then it is OK. Other means of eval have come and gone. Sometimes not because the tool is bad but the human factor is not up to it, or the device doesn't work well in the field.
Anecdote: in an a preliminary effort to see if increased respiratory effort in chemical warfare gear caused lowered blood oxygen levels, I put a person in a double N95 mask (about the same resistance as the MCUP2 or a leaky M17 mask) and had him do jumping jacks until he was very short of breath. Didn't take long. Pulse ox still said he was fine, but in truth he was building enough CO2 up to cause the sensation of breathlessness (a primary symptom of low level CO2 poisoning is an increased respiratory drive, same as ammonia). If he had had underlying coronary disease this could have been serious.
Lots of confounders to pulse-ox, especially in the venues of cold extremities, nail polish, poor distal circ, and damaged probes.
MSDeltaFlt
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very true. One needs to know, when using any piece of equipment to monitor a pt, when said equipment is telling you the truth and when it is lying to you. Just like people, tools lie.
Brandon O
Puzzled by facies
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I ran through some rather exhaustive and probably exhausting thoughts here:
http://emsbasics.com/2011/08/03/respiration-and-hemoglobin/
http://emsbasics.com/2011/08/05/pulse-oximetry-basics/
and particularly http://emsbasics.com/2011/08/07/pulse-oximetry-application/
http://emsbasics.com/2011/08/03/respiration-and-hemoglobin/
http://emsbasics.com/2011/08/05/pulse-oximetry-basics/
and particularly http://emsbasics.com/2011/08/07/pulse-oximetry-application/
Joe
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all i know is when there sating 90 and i put them on a nrb they sat at 96ish...as long as the number goes up im happy haha
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the_negro_puppy
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Joe
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Really?
haha busted! I B TROLLIN :rofl:
JPINFV
Gadfly
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Fine, I'll bite. Just about everything I've ever seen said has placed the hypoxia threshold north of 90. Sure, there are conditions where it's not "ZOMG, lights and sirens," and conditions where about 90 would be considered normal, but if high concentration O2 only manages to get a patient up 6 points without hitting 99/100, then I'm hard pressed to argue it wasn't justified. Sure, titration would be better, but we aren't necessarily talking about a patient who is saturated yet.
However, I'd like a little more of a thought process than, "Huh, me cave EMT. Me see low number. Me make number rise. Me happy cave EMT."
However, I'd like a little more of a thought process than, "Huh, me cave EMT. Me see low number. Me make number rise. Me happy cave EMT."