# PulseOx for BLS, I need reasons!



## MMiz (Feb 12, 2005)

When I first started at this company all of our units carried PulseOx units.  Our BLS units started leaving them on scene and losing them, so it was decided that they would be removed from the trucks.   Our Paramedic First Responders, ALS, and Critical Care still have them on their LifePak 12s, but we just don't have the individual units ($650 retail).

This company I work for is great, and they always provide us with great equipment.  Patient care has never suffered because of not having a PulseOx, but I think it was a great tool to have.

This really isn't about money, we have many backup LifePaks, AEDs, and all that other good stuff.   But I do understand not wanting to be wasteful, especially after losing so many units.

Do you think a PulseOx is an essential tool for BLS?


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## Summit (Feb 12, 2005)

Where I am at (high altitude) it is a very usefull tool
AMS
HACE
HAPE
Sickel Cell Trait
Neonates
Emphysema
etc etc etc


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## emtbuff (Feb 12, 2005)

We have a pulse ox on our automated BP cuff machine.  We generally start taking a manual BP while in the house and once in the rig we hook the pt up to the automatic and check the pulse ox.  Then generally decide if we want to lower the O2 setting or if we need to give them more.


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## GFD940 (Feb 12, 2005)

Don't the ER docs complain about not having an initial O2 sat?  I know most of mine like to know what it was prior to us loading them up on O2.  Then again EMS was going on 20 years ago before we had pulse ox.


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## PArescueEMT (Feb 13, 2005)

> _Originally posted by emtbuff_@Feb 12 2005, 04:30 PM
> * once in the rig we hook the pt up to the automatic and check the pulse ox.  Then generally decide if we want to lower the O2 setting or if we need to give them more. *


 I love having mine... many reasons behind this, but it is all a personal opinion.

I remember in EMT school, the one thing the instructor always harped on: 
"Treat the Patient, Not the machine"

i.e. if the Pt. is asymptomatic for an MI, why treat them for an MI?


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## shorthairedpunk (Feb 13, 2005)

The pulsox is my best friend. ITs a great indicator for change in patient status. Its just one of the many tools available to us, but its easy to use, simple to remove if neccessary, a fireman even showed me once that it works well as an indicator od adequate compressions and oxygenation during CPR.

They are expensive, but in the case of respiratory distress calls it gets you a good baseline on the patient, takes about two seconds to see what their room air sat is, and then you can assess the result of your treatment more thoroughly. The first thing most ERs do when you bring a patient in on O2 is get a room air, for this very reason.

They have that new pulsox out there thats like 2 inches by two inches, that is just begging to get lost


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## Summit (Feb 13, 2005)

Just remember... pulseox lies in CO and cyanide poising cases.

edit: also they may not work with hypothermic pts


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## Jon (Feb 13, 2005)

> _Originally posted by GFD940_@Feb 12 2005, 05:53 PM
> * Don't the ER docs complain about not having an initial O2 sat?  I know most of mine like to know what it was prior to us loading them up on O2.  Then again EMS was going on 20 years ago before we had pulse ox. *


 SPo2 is a nice toy, but not essential. However, if you can, it inver hurts to have another diagnostic tool. (Think 12 lead vs. 3)

What I don't like is the attitude that a patient with a 99 - 100% sat. "Doesn't need O2." as was said, may a thing can fool a pulse ox.

worst case, ask your employer about "chaining" the unit to the truck, like Staples does with the demo digital cameras - won't prevent a determined thief, but will prevent an accidental loss onscene.


Jon


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## rescuecpt (Feb 13, 2005)

Pulse ox also lies with patients on blood thinners (not always, but keep it in mind).


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## snoslicer8 (Mar 11, 2005)

PulseOx may be unreliable at times, this much is true...who's up for on-the-go ABGs?!?


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## Jon (Mar 11, 2005)

> _Originally posted by snoslicer8_@Mar 11 2005, 11:25 AM
> * PulseOx may be unreliable at times, this much is true...who's up for on-the-go ABGs?!?   *


 I wish...

jon


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## Jon (Mar 11, 2005)

Also doesn't work with SEVERE hypotension.


Jon


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## Summit (Mar 11, 2005)

> _Originally posted by MedicStudentJon_@Mar 11 2005, 12:04 PM
> * Also doesn't work with SEVERE hypotension.
> 
> 
> Jon *


 Saw this the other day. The guys systolic was below 65 (the receiving hospital could barely get it manually with dopplar). Pulseox no workee!


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## Jon (Mar 11, 2005)

> _Originally posted by Summit+Mar 11 2005, 12:42 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (Summit @ Mar 11 2005, 12:42 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-MedicStudentJon_@Mar 11 2005, 12:04 PM
> * Also doesn't work with SEVERE hypotension.
> 
> 
> Jon *


Saw this the other day. The guys systolic was below 65 (the receiving hospital could barely get it manually with dopplar). Pulseox no workee! [/b][/quote]
 Had it last night on what the Nursing home had called in to the ED quote charge nurse "they said this was a BS change in mental status."

rest of post HERE:http://www.emtlife.com/index.php?showtopic...st=0&#entry6836


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## TTLWHKR (Mar 11, 2005)

I leave the pulse ox in the cabinet w/ the "Extras".. Extra lifepak, extra suction, cylinders, etc... B/c I have no use for it at all on my BLS rig. Too many BLS providers treat what they see on the screen. If the person is having diff breathing, but are 100%, some won't use oxygen.

We're gonna put O2 on them anyway, can't do any treatments; so I just leave it in the cabinet. I don't think it works half the time anyway. Especially in the winter, e.g. Cold Hands.

Our unit is a combo; Pulse Ox, Auto BP, O/R Thermometer, and has these tiny bands that go on the wrists and work like an EKG. It's a heavy, worthless tool; that was given to them for free by a hospital and they don't want to piss anyone off by throwing it in a closet with other worthless pieces of equipment from the past 40 years. It ranks right up there with the four dozen different, worthless resuscitator units from the 1950's that were donated and haven't been thrown out yet.


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## Jon (Mar 11, 2005)

> _Originally posted by Blueeighty8_@Mar 11 2005, 02:54 PM
> * I leave the pulse ox in the cabinet w/ the "Extras".. Extra lifepak, extra suction, cylinders, etc... B/c I have no use for it at all on my BLS rig. Too many BLS providers treat what they see on the screen. If the person is having diff breathing, but are 100%, some won't use oxygen. *


 Yep. Thought school said to treat the PATIENT's signs and symptoms.



> * Our unit is a combo; Pulse Ox, Auto BP, O/R Thermometer, and has these tiny bands that go on the wrists and work like an EKG. It's a heavy, worthless tool; that was given to them for free by a hospital and they don't want to piss anyone off by throwing it in a closet with other worthless pieces of equipment from the past 40 years. *



I'll take it.



> *It ranks right up there with the four dozen different, worthless resuscitator units from the 1950's that were donated and haven't been thrown out yet.*



Do they involve demand valves? I want a demand valve!  

jon


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## Summit (Mar 11, 2005)

> _Originally posted by Blueeighty8_@Mar 11 2005, 02:54 PM
> * I leave the pulse ox in the cabinet w/ the "Extras".. Extra lifepak, extra suction, cylinders, etc... B/c I have no use for it at all on my BLS rig.
> Our unit is a combo; Pulse Ox, Auto BP, O/R Thermometer, and has these tiny bands that go on the wrists and work like an EKG. It's a heavy, worthless tool; that was given to them for free by a hospital and they don't want to piss anyone off by throwing it in a closet with other worthless pieces of equipment from the past 40 years. *


 I'd love to take that off your hands for $20


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## TTLWHKR (Mar 11, 2005)

> _Originally posted by MedicStudentJon_@Mar 11 2005, 04:10 PM
> *
> Do they involve demand valves? I want a demand valve!
> 
> jon *


 I may be able to help you with that...


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## Ray1129 (Mar 15, 2005)

> _Originally posted by MedicStudentJon_@Feb 13 2005, 05:43 PM
> *worst case, ask your employer about "chaining" the unit to the truck, like Staples does with the demo digital cameras - won't prevent a determined thief, but will prevent an accidental loss onscene.*


*giggles*  Isn't the whole point of having an individual pulse-ox machine to take it into the house.  I hope you have a REALLY long chain.


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## rescuecpt (Mar 15, 2005)

Something to remember about pulse ox's too... they are most useful when you know a BEFORE 02 and ON 02 reading...  the hospital always asks me what they were on room air - so unless the PT is in severe distress I usually take the 2 seconds to check before I put them on high flow.


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## emtbuff (Mar 15, 2005)

Ok our pulse ox is part of our automatic BP cuff which is kept in the rig.  I know we had it bolted down at one point in time but now I think there is a strap that holds it down to the counter.  So we usually don't use it unless we are on a transfer and monitoring of the pulse ox either has to be done or not.   But at the hospital that I work at when I do vitals I check pulse ox every time.


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## Phridae (Mar 21, 2005)

We have a pulseOx in every truck, in the jump bag. Then, in the front line truck, we have a combo BP/SPO2 machine. Hardly gets used though. False reading with the bumps, its been named the boat anchor. Good for nothing else.

I think if we lost one of our pulseOx's, we'd all be dead. My chief would hang us all. Yep.


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## SCEMT-B (Mar 22, 2005)

:blink: Another tip Pulse Ox wont work on a pt with Parkinsons Desease, nor on anyone who is shaking violently, just wont get a good reading at all unless you change out the finger clamp with a strip and find a stable area to place the strip for a reading.


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## Ray1129 (Apr 3, 2005)

> _Originally posted by SCEMT-B_@Mar 22 2005, 11:16 PM
> * :blink: Another tip Pulse Ox wont work on a pt with Parkinsons Desease, nor on anyone who is shaking violently, just wont get a good reading at all unless you change out the finger clamp with a strip and find a stable area to place the strip for a reading. *


It's also like that with cold fingers/toes.  You won't get a reading, and if you do, it's usually wrong.


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## KEVD18 (Apr 14, 2005)

cute toy but of negligible clinical value in the prehospital setting


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## cbdemt (Apr 15, 2005)

> _Originally posted by KEVD18_@Apr 14 2005, 09:43 PM
> * cute toy but of negligible clinical value in the prehospital setting *


 I've got to disagree with ya on that.  Its crucial to be able to monitor your pts O2 levels, its one of the few things that we B's can fix (or at least attempt to fix).  Just a quick example off the top of my head... You get called for an unknown medical, find a pt that is conscious but disoriented and alone.  It could be any number of things; OD, diabetic problem, hypoxia, or post ictal to name a few.  If you can slap on a pulse ox it can at least point you in the right direction and allow you to focus your treatment a little better.

As for ALS in my area, pulse ox must be monitored before during and after med admin's. 

I think it’s a very valuable tool (that is under used as far as I've seen).  

Just my thoughts, be safe all!


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## ffemt8978 (Apr 15, 2005)

We were called to to an 87yoF C/C abdominal pain.  Upon arrival, we find the patient in obvious respiratory distress and C/O chest pain 10/10 that radiates around the right side to her back.  Initial vitals: Pulse 200+ (too fast to count), Pulse on Pulse Ox 230, SPO2 on RA was 79%, patient was diaphoretic and had a HX of HTN and Renal Failure.

We put her on 15lpm O2 via NRB and do a PUHA to an ALS intercept.  By the time we met with ALS, her pulse was 113, SPO2 was 96% and her pain was at a 5/10.  

The reason I bring this call up is this.  By our protocols, EMT-B's can only give 15lpm O2 via NRB.  They can't dial it down if the patient doesn't need that much O2.  As an EMT-IV, I can titrate the O2 to keep the patient's sats above 90%.  Most of the time, I leave it a 15lpm (as I did in this case), but sometimes I will drop it down to 10lpm.  It's nice to have that option for certain patients (COPD), and if it requires a Pulse Ox, then so be it.

I know we're all taught that we don't treat our equipment, but treat the patient instead.  However, Pulse Ox before and after the administration of O2 is a great way to determine how effective the O2 is.


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