# Pulse Oximeter and EMT-B



## rhan101277 (Aug 29, 2008)

Here is Mississippi EMT-B's are not allowed to use these.  In other states like Alabama they can.  It sure would be nice if all the states would come up with the same protocols after all we are trying to save lives.  Also paramedics are not allowed to do cric's here either.

Anyhow back on topic, we can't use these due to they think we don't have enough training.  Yet CNA's can use them.  I understand that most units can't tell the difference between oxyhemoglobin and carboxyhemoglobin, which can lead you to think Sp02 is good when it is not.  Also it doesn't tell you how good prefusion is etc.  I could spend some time talking about what it does and doesn't do, with my somewhat limited knowledge.  The point is it should be used as a tool and to compare with other assessments, but not to go on that one reading alone.  Also fingernail polish and sunlight etc. can effect readings.  I just don't understand how come some states let them and some don't.  After all aren't we all trained to the same national standard?


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## Flight-LP (Aug 29, 2008)

rhan101277 said:


> Here is Mississippi EMT-B's are not allowed to use these.  In other states like Alabama they can.  It sure would be nice if all the states would come up with the same protocols after all we are trying to save lives.  Also paramedics are not allowed to do cric's here either.
> 
> Anyhow back on topic, we can't use these due to they think we don't have enough training.  Yet CNA's can use them.  I understand that most units can't tell the difference between oxyhemoglobin and carboxyhemoglobin, which can lead you to think Sp02 is good when it is not.  Also it doesn't tell you how good prefusion is etc.  I could spend some time talking about what it does and doesn't do, with my somewhat limited knowledge.  The point is it should be used as a tool and to compare with other assessments, but not to go on that one reading alone.  Also fingernail polish and sunlight etc. can effect readings.  I just don't understand how come some states let them and some don't.  After all aren't we all trained to the same national standard?



I definately understand your frustration, there is no reason why you should not have access to pulse oximetry as an adjunct to a thorough assessment. You seem to have a grasp on the limitation and cons to its use, I guess you are smarter than the MS. D.O.H. believes you to be..........................

I'm not sure about your Cric statement though. The last air medical service I worked with had a couple of bases in Mississippi and there was not a limitation for their flight crews. MSDeltaFlt would be the resident expert on this subject. He still works for them................


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## Buzz (Aug 29, 2008)

I believe we're allowed to use them here, not that it really makes much of a difference to us since our service hasn't purchased them. If we have a SOB patient from a nursing home we'll ask the nursing staff what the pulse ox was because it would be nice to tell the hospital what it was, but we're still placing them on appropriate O2. Check their fingers and conjuntiva for signs of perfusion instead and recheck their respritory rate to see if a treatment is working... It's a nice tool, but it's far too easy to get caught up focusing on the number which can be completely inaccurate for any of those reasons you suggested anyways.


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## rhan101277 (Aug 29, 2008)

Flight-LP said:


> I definately understand your frustration, there is no reason why you should not have access to pulse oximetry as an adjunct to a thorough assessment. You seem to have a grasp on the limitation and cons to its use, I guess you are smarter than the MS. D.O.H. believes you to be..........................
> 
> I'm not sure about your Cric statement though. The last air medical service I worked with had a couple of bases in Mississippi and there was not a limitation for their flight crews. MSDeltaFlt would be the resident expert on this subject. He still works for them................



Maybe fight medics can use them, but according to our instructor paramedics can not.


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## KEVD18 (Aug 29, 2008)

the biggest thing i can tell you is you dont need one. sure, its nice to have, its a cool toy, it allows you to answer a question the nurse at the er will inevitably ask. but its not by any means necessary.

answer me this: how will it change your treatment? if your patient complains of difficulty breathing and presents with obvious respiratory distress. posturing, diaphoresis, cyanosis, the works. but your pulse ox says he's sating at 100%, are you going to withhold O2? of course not. you're going to give it to him and disregard the sat reading.

and the other side of the coin. you have a patient with sos L toe pain. no respiratory complaint whatsoever. you put the oximeter on him and it says 92. now midd you his color is great, he's breathing normally and comfortably. his only deal is he dropped a brick on his toe. are you going to immediately fire up high flow high concentration o2? of course not. it would be a waste of gas. 

its a tool that provides a number that only has a reasonable chance of being accurate. sure, theres no logical reason why you shouldnt be able to use them. i cant think of a less invasive procedure we do. i would push for glucometers or combitubes or neb's and save my breath on the oximeters. 

but thats just my opinion....


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## mycrofft (Aug 29, 2008)

*YES! Cutting to the chase! Y'all are tops.*

All my coworkers are in love with then little beeping lovelies and I actually used one today, but mostly just to listen to the reassuringly steady "beep" as I was doing other things, and to reassure the pt.
I once wore three N-95 masks, jumped up and down until I was winded, and before I tore off the masks and snorked real air the POx read "97%", which is better than my resting usual of 95 or so (no snide remarks!!). It was reflecting my increased peripheral cooling circulation, not my oxygenation.

Know your basic clinical skills and watch/talk to your patients!!


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## VentMedic (Aug 29, 2008)

mycrofft said:


> I once wore three N-95 masks, jumped up and down until I was winded, and before I tore off the masks and snorked real air the POx read "97%", which is better than my resting usual of 95 or so (no snide remarks!!). It was reflecting my increased peripheral cooling circulation, not my oxygenation.


 
N-95s aren't designed to make you hypoxic even if you double up which can actually cause leaks.  They are often worn for extended periods of time although I prefer my battery pack if I'm in the room for more than 1 hour.  

If you want to stress yourself, get your PFT/RT department to do a HAST with exercise to simulate mountain climbing.


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## KEVD18 (Aug 29, 2008)

my favorite pulse ox story:

one day, im talking to one of my coworkers about pulse oximetry. she stated that it was completely inaccurate if the patient had recently had a cigarette. i of course told her she was mistaken, but she was adamant. so, as was frequent during my tenure with that particular company, it was experiment time.

the background: im a pack a day smoker and have been for like 7 years.

so we grab the m series of my truck and i grab a chair. turn it on, hook it up and i proceeded to sith there for at least 30 min during which time i smoked maybe 3 or 4 cigarettes. never, not once, not even for a second did my saturation drop below 97% which is my baseline.

the sad part, about a week later i overheard her laying the same rap on someone else....

we tested lots of theories at that company.....


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## Hastings (Aug 29, 2008)

KEVD18 said:


> my favorite pulse ox story:
> 
> one day, im talking to one of my coworkers about pulse oximetry. she stated that it was completely inaccurate if the patient had recently had a cigarette. i of course told her she was mistaken, but she was adamant. so, as was frequent during my tenure with that particular company, it was experiment time.
> 
> ...



It actually is true though. It doesn't mean that it will always give an inaccurate reading. It means that it CAN. And that's why pulse ox is a tool that should be used, but not depended on.


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## VentMedic (Aug 29, 2008)

Your SaO2 probably did drop but was replaced by COHb. You also probably maintained a 3 - 5% COHb level on a normal day with your smoking. 

We will not even bother titrating a smoker on home O2 if they just had a cigarette. Co-oximetry would have to be ran first and then blah blah blah. They probably don't stay on the liter flow we put them on anyway and adjust to their needs. 

People can present with 100% SpO2 and be very hypoxic from heavy smoking or smoke inhalation. 

Unfortunately children are very susceptible to second hand smoke and when co-oximetry is done, their COHb level rivals that of the adult.


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## KEVD18 (Aug 29, 2008)

vent, thats exactly what im saying. its an inaccurate device. it only give you a number that most providers have no real understanding of. "oh 97%. great" when in fact my SaO2 was probably more like 93-95.


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## VentMedic (Aug 29, 2008)

Get a Masimo RAD 57.   Only about $5K.


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## mycrofft (Aug 29, 2008)

*Peripheral vasoconstriction versus POx...PV wins.*

The N95's were just to make me work harder to breathe, I had three good seals (wish I had a good old M-17 instead) but my sedentary ways and adipostity were the real effort-makers. Next time I'll use a lab Baggie, but I'm not doing it for free!

PS: I can sit there with digital thermo and POx and make them start descending...that in combo with my PAT can scare a coworker who doesn't know my little quirks


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## MSDeltaFlt (Aug 29, 2008)

Rhan, here's the deal.  No matter what school you attend, you'll be taught a broader scope than you'll be able to practice.  MS DOH is getting there, but, like all states, they still have a way to go in different places.

For example, MS medics/intermediates have been able to place combitubes for several years now,  AR medics have only recently been able to do so.  Basics are no different from state to state.  Step across the ditch (MS River) and you'll see.

As far as cric's go, we CAN do crics on the trucks.  Only needle crics.  Even in the air we are only allowed to use needles.  The NURSES, however, can do surgical crics.  But then again, that's just in our neck of the woods.  Go to another state and it'll be different.

Hope this helps


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## rhan101277 (Aug 30, 2008)

Thanks for all the good info.  Why use a oximeter anyway, if its just gonna give you a warm fuzzy feeling.  As others have said its just a adjunct.  There is much good reading to be done on how different types of hemoglobin react to the wavelength of light that the device uses to detect such things.  While smoking may not immediately effect your SpO2 it will in time reduce the capacity of your lungs.  It will make your alveoli become hardened and it will not be able to expand as much.  This is why smokers get so exhaused during heavy exercise.  Again this is a beginners judgement.


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## KEVD18 (Aug 30, 2008)

its not completely useless, just a lot less useful than some people want to believe. 

one of the i do like having it around is to monitor the effectiveness of treatment. if the asthma patient is sating in the high 80's when i get there and i give them a combivent, its nice to be able to have a before and after number to go along with my assesment.

its just dissapointing to see people rely on it to make their decisions for them. sort of like gps nav v. map books. sure its nice to have the toy, but if you dont have the basic skills down before getting the toy, you never will.


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## mikie (Aug 30, 2008)

just remember, "treat the patient, not the machine!"


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## Flight-LP (Aug 30, 2008)

MSDeltaFlt said:


> As far as cric's go, we CAN do crics on the trucks.  Only needle crics.  Even in the air we are only allowed to use needles.  The NURSES, however, can do surgical crics.  But then again, that's just in our neck of the woods.  Go to another state and it'll be different.
> 
> Hope this helps



Interesting, I didn't realize this. So how often do you have to fly east to cross the state line and cric someone?


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## MSDeltaFlt (Aug 30, 2008)

Sssssshhhhhh!!!  they think we were dodging storms.


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## Flight-LP (Aug 30, 2008)

Like Datalink would actually know any better.....................

Keep it safe!


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## Mongoose (Sep 12, 2008)

*Re: Pulse Ox and EMT-B*

Here in California we can use them. Some of our "Ricky Rescuer" EMT's actually go out and shell out $300+ for a pocket PulseOx that is horribly unreliable anyway.

In my opinion it is more of a nicety than anything else. My recommendation: Use your general impression right when you first establish contact to determine if the pt needs o2. If the general impression isn't a good enough indicator typically you will know by the time you've assessed their alert status and gotten the chief complaint.


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## marineman (Sep 12, 2008)

We carry them but I could probably count the number of times I used it on one hand. 95% of the time you can get a good enough idea just by looking at the patient. Like was mentioned sometimes it's good to get hard numbers for the effectiveness of your treatment but too many people get in the habit of hooking it up every time and treating the machine.

I can't believe how different some protocols are throughout the states. Up here our first responders have been doing combitubes for several years now.


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## traumateam1 (Sep 12, 2008)

We are allowed to use there here in BC at my level. I use them and don't mind them. However keep in mind. Treat the patient, not the machine.


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## JPINFV (Sep 12, 2008)

Mongoose said:


> Here in California we can use them.


Depends on which county you are in.


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## TheMowingMonk (Sep 13, 2008)

Yeah here in Santa Clara County if your in the county system your not allowed to use them. I like having the reading from it though, cause like every nurse asks for what it was when we pick them up (even if they already know we are a BLS unit and cant take them) so to fix it if were doing our usual IFTs ill ask the nurse or the CNA to take one right before we go, and if they are warm or anything i usually get a temp from them too (Since like pulse ox taking a tempurature is too much for an EMT in santa clara county. but not to much for joe shmoo.....) anywho i think alot of the restrictions on EMTs are rediculus but thats my own rant. but point is JPINFV is right, its a county by county thing even though according to title 22 for california law it is legal on the state level.


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## Scout (Sep 13, 2008)

They are great for kids.


Slap it on and get them to make the pulse number as low as possible, treat it as a game.


Works wonders to calm them down. That and on long transports where i'm filling in every field on the PCR and chatting away with the Pt. only times i have used them.


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## pumper12fireman (Sep 13, 2008)

I'm not a huge fan of pulse ox in the field. In EMT school it sounded like a great idea, but in actual practice I rarely use it to decide whether or not to place a pt. on O2. I use it to fill in the little box on the report. Or, to help determine how well a certain tx is working. It also doesn't seem to work on older people, people with a bradycardia, people with any kind of fingernail polish, and the numbers love to jump around in the back of a moving ambulance. I think color, mental status, and other factors are much more concrete in deciding a treatment plan.


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## EMTDON970 (Sep 13, 2008)

I have my own Pulse Ox (dont ask), I use it often, but again I treat my patient, not the machine.


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## Jon (Sep 13, 2008)

pumper12fireman said:


> I'm not a huge fan of pulse ox in the field. In EMT school it sounded like a great idea, but in actual practice I rarely use it to decide whether or not to place a pt. on O2. I use it to fill in the little box on the report. Or, to help determine how well a certain tx is working. It also doesn't seem to work on older people, people with a bradycardia, people with any kind of fingernail polish, and the numbers love to jump around in the back of a moving ambulance. I think color, mental status, and other factors are much more concrete in deciding a treatment plan.


Yep.


I really want to take it away from the new EMT's at my squad. When I start precepting officially - I plan on asking the preceptee to be able to JUSTIFY why they want the pulse ox.

I enjoy rocking the boat occasionally.


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## Foxbat (Sep 20, 2008)

How does O2 amninistration helps if pt. truly has 100% SpO2? If the problem is in poor blood circulation or O2 absorption by tissue rather than in % of hemoglobin attached to oxygen, why would increasing O2 content in inhaled air help? I obviously would give O2 to pt. in respiratory distress with 100% SpO2, I am just curious why.


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## flhtci01 (Sep 21, 2008)

Buzz said:


> I believe we're allowed to use them here, not that it really makes much of a difference to us since our service hasn't purchased them. If we have a SOB patient from a nursing home we'll ask the nursing staff what the pulse ox was because it would be nice to tell the hospital what it was, but we're still placing them on appropriate O2. Check their fingers and conjuntiva for signs of perfusion instead and recheck their respritory rate to see if a treatment is working... It's a nice tool, but it's far too easy to get caught up focusing on the number which can be completely inaccurate for any of those reasons you suggested anyways.



Recently had a nursing home SOB.  They stated pulse ox was 27 before our arrival. They had the pt on 2 lpm NC SpO was 88. The 27 was a good laugh in the ER.  Remember 'Trust but verify'.


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## VentMedic (Sep 21, 2008)

flhtci01 said:


> Recently had a nursing home SOB. They stated pulse ox was 27 before our arrival. They had the pt on 2 lpm NC SpO was 88. The 27 was a good laugh in the ER. Remember 'Trust but verify'.


 
Why the laugh? That actually can be possible. A little stimulation and O2 can bring someone back from an SpO2 like that. If anyone has ever worked in an ICU or observed babies, they would know this. Granted it does take matching the patient and machine, but that is a very possible situation. Pulse Ox machines do loose their accuracy at lower saturations so it is difficult to tell what the actual SpO2 is below 75%.  Some COPD patients drop their SpO2 like a rock but bounce right back with 2 L.  It all depends on where their oxyhemoglobin dissociation curve lies.


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## traumateam1 (Sep 21, 2008)

"Treat the patient, not the machine"
How was this SpO2 of 27 p/t breathing while at 27. Was there cyanosis, or severe SOB or difficulty breathing? If so than 2 Lmp NC is obviously a horrible way to treat the p/t. However if they are breathing fine and just a little low on the SpO2 monitor than I guess you could give 2 Lmp. PERSONALLY (depending on p/t hx) I would give them higher flow O2 just to bump their SpO2 to low 90's at least. However 88 isn't bad.


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## Ridryder911 (Sep 22, 2008)

VentMedic said:


> It all depends on where their oxyhemoglobin dissociation curve lies.



Now come on Vent... Your talking old school now! I doubt very few Paramedics know what that is...

R/r 911


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## traumateam1 (Sep 22, 2008)

YEAH! Lets keep this simple easy words now Vent. What's wrong with you?!?  
No just kidding, but when I see something like that that I have no idea what it is I go and Wiki it, and the Google it if Wiki doesn't have anything on there.. great way to continually learn! 

"The oxyhemoglobin dissociation curve is an important tool for understanding how our blood carries and releases oxygen. Specifically, the oxyhemoglobin dissociation curve relates oxygen saturation (SO2) and partial pressure of oxygen in the blood (PO2), and is determined by what is called "hemoglobin's affinity for oxygen," that is, how readily hemoglobin acquires and releases oxygen molecules from its surrounding tissue."


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## marineman (Sep 22, 2008)

Ridryder911 said:


> Now come on Vent... Your talking old school now! I doubt very few Paramedics know what that is...
> 
> R/r 911



You're right, but just because you said that I googled it B)


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## VentMedic (Sep 22, 2008)

A few of the things you should know about oxygen:

http://www.ccmtutorials.com/rs/oxygen/index.htm


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## traumateam1 (Sep 22, 2008)

And this is why we LOVE you Vent. 
You have information for everything that any of us at any time have a question for. Thank you for the link.. gonna read it and learn something new! Woohoo lol.



Sorry everyone.. a little hyper tonight. But really Vent, we LOVE you!


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## VaEMT66 (Sep 22, 2008)

I can understand your frustration.  We use the LIFEPAK-12, and our protocols allow its use.  However, the county next to us, is not allowed to use it, nor are they allowed to automatically give glucose to a diabetic patient.  They have to call the their local hospital and ask for permission.

Jeff


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## Jon (Sep 22, 2008)

Are you a BLS or ALS service? At the BLS level, what are you using a Lifepak 12 for?


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## VaEMT66 (Sep 23, 2008)

We have about 120-130 members (+/-)..most of us(me included) are the BLS providers.  However, we have many members (30 or more) who are ALS providers.


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## BossyCow (Sep 24, 2008)

Jon said:


> Are you a BLS or ALS service? At the BLS level, what are you using a Lifepak 12 for?



Some BLS agencies are going to the 12 lead in order to have a strip for ALS to view that is taken earlier in the event. It's not for BLS to diagnose, but more for evidence gathering. Doc in our state is pushing for it for early diagnosis of a STEMI


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## laina66 (Sep 25, 2008)

In NY state we are allowed to use these--- I use this on almost every patient I get. Especially ETOH...as does most of my crew members.
When dealing with other situations it is still good to have a reading down on the PCR and worry more about this when you get to the ER (unless it's crazy far...) In all honesty, you're probably going to put o2 on the pt anyway so why not?


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## mikie (Sep 25, 2008)

BossyCow said:


> Some BLS agencies are going to the 12 lead in order to have a strip for ALS to view that is taken earlier in the event. It's not for BLS to diagnose, but more for evidence gathering. Doc in our state is pushing for it for early diagnosis of a STEMI



I believe there is a pilot program in MD starting soon where basics will do 12 lead, not for interpretation though, just to send to the hospital.


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## sixmaybemore (Sep 29, 2008)

> Remember 'Trust but verify'.



I have a pocket pulse ox. I managed to finagle one from my insurance company ($900). My 3 yo has WPW. He also had RSV when he was a baby, and we had subsequent asthma issues to deal with. I have found that when his numbers are too low (or too high, depending on which side I'm looking at) that the unit, or my knowledge of how to use the unit, is automatically questioned. As a parent, I find that frustrating. I'd like to at least be *believed* that it said what it said (FTR, if the numbers come out off, I recheck using the other hand. If it's for HR I verify with a manual count). Recheck with the unit at the ER, that's fine. But please don't act like I don't know how to use a pulse ox. Sigh. 

Lots of good information here. And a good link to read on O2, which I'm gonna go do now....


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## VentMedic (Sep 29, 2008)

Parents are much easier to teach than some EMS students. They have a vested interest to learn. They may also get many more hours of training by many different medical professionals with various areas of expertise. We do try to respect what our parents tell us from their observations especially if we know the parents and child have spent a great deal of time in the hospital. Usually all they have to do is mention the disorder or disease history and we will have some idea of what their lives have consisted of. 

For those who are not familiar with RSV: 
(registration is free and the on demand courses are interesting)

https://www.rsvuniversity.org/


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## sixmaybemore (Sep 29, 2008)

GREAT link, thank you for posting that!


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## thatrescueguy (Oct 5, 2008)

Here in NY we are allowed to use them, but I don't recall it being covered in EMT class. We also have Rad 57's for CO alarms and FF rehab. (They also have a pulse ox function.) I find them useful and highly accurate. They are especially helpful when you are treating more than one patient, because it frees up your hands to do something else, like a BP.


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## KEVD18 (Oct 5, 2008)

thatrescueguy said:


> I find them useful and highly accurate.
> 
> 
> 
> ...


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## thatrescueguy (Oct 6, 2008)

Why is that? Do you usually find that they don't work?


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## MAEMT (Oct 24, 2008)

We are allowed to use them @ all levels in Massachusetts. However they are to be used as a tool only. If Carbon Monoxcide is suspected we have another "tool" the rad 57 to detect carbon monoxcide levels. this especially comes in handy on fire scenes to detect levels in our department firefighters. Both devices are to be used by EMT's @ all levels as strictly a tool and nothing more. It basically is used to get somewhat of a baseline of where our patient is at.


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## rhan101277 (Oct 24, 2008)

Yeah they are good tools.  A good blood oxygen level doesn't mean they are getting good perfusion.  That is why it is good to do all of your assessment.


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## dcap-btls (Nov 2, 2008)

I originally took my class in 2001 I have since spent 6 years in the Marine Corps so my certification has expired but I do specifically remember we used Pulse ox in my class. But I will be heading back to the class room next month so I will let you know.


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## Mercy4Angels (Nov 2, 2008)

who cares just use it. I have a nice finger pulse ox i use on every call i just keep it in a pouch on my belt. CNAs are so far below us all they do is clean old peoples butts. they seriously pi$$ me off to no end. they dont talk english and think they are better than they are. they are the bottom of the barrel my friend they should never ever ever have anything medically related in their hands. This also goes for nursing home nurses. they only work there cause they couldnt get a real job. at least thats how it is here. i vote use the pulse ox. i cant wait to do et tubes, ivs, meds, cpap, ect....very very soon !


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## jrm818 (Nov 2, 2008)

Note to self: never get sick in NJ...if the CNA's don't get you, the EMT's will...

somebody pass the popcorn...


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## JPINFV (Nov 2, 2008)

Mercy4Angels said:


> i cant wait to do et tubes, ivs, meds, cpap, ect....very very soon !



Why does this scary me?


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## Ridryder911 (Nov 2, 2008)

Mercy4Angels said:


> who cares just use it. I have a nice finger pulse ox i use on every call i just keep it in a pouch on my belt. CNAs are so far below us all they do is clean old peoples butts. they seriously pi$$ me off to no end. they dont talk english and think they are better than they are. they are the bottom of the barrel my friend they should never ever ever have anything medically related in their hands. This also goes for nursing home nurses. they only work there cause they couldnt get a real job. at least thats how it is here. i vote use the pulse ox. i cant wait to do et tubes, ivs, meds, cpap, ect....very very soon !



I am assure your just joking. If not God help us and your patients because...

[size=+4]You obviously know nothing about medicine, nursing nor EMS![/size]

Just a note to say thanks for spouting off ignorance! Obviously, in your vast knowledge and training of a whopping first-aid class you know so much, right? 

C'mon, all you can do is slap on a band-aid and drive r-e-a-l fast!..

I will conclude this.. at least nurses aides and even nursing home nurses are educated enough to recognize their limitations and place in medicine. Something that EMT"s could learn from them.  


p.s. English should be capitalized..since you wanted to point out ignorance.


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## NRCCEMTP26 (Nov 2, 2008)

The only thing a portable O2sat meter is a good stretcher wheel chauk. treat the problem not the equipment. remember back you your basic skills, the time you have the pt a little O2 will not kill the pt. when in doubt O2 out


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## JonTullos (Nov 2, 2008)

Mercy4Angels said:


> who cares just use it. I have a nice finger pulse ox i use on every call i just keep it in a pouch on my belt. CNAs are so far below us all they do is clean old peoples butts. they seriously pi$$ me off to no end. they dont talk english and think they are better than they are. they are the bottom of the barrel my friend they should never ever ever have anything medically related in their hands. This also goes for nursing home nurses. they only work there cause they couldnt get a real job. at least thats how it is here. i vote use the pulse ox. i cant wait to do et tubes, ivs, meds, cpap, ect....very very soon !



This has to be the most ignorant statement I've ever read.  Please tell me that you were just having a really bad day and that you just typed the first bit if stupidity that came to your brain.  

I hope I never work on a squad with someone who thinks like this.


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## stephenrb81 (Nov 2, 2008)

Mercy4Angels said:


> CNAs are so far below us all they do is clean old peoples butts. they seriously pi$$ me off to no end. *they dont talk english* and think they are better than they are. they are the bottom of the barrel my friend they should never ever ever have anything medically related in their hands. _This also goes for nursing home nurses. they only work there cause they couldnt get a real job_. at least thats how it is here. i vote use the pulse ox. i cant wait to do et tubes, ivs, meds, cpap, ect....very very soon !



The only thought I can come up with is *WOW*.  Just WOW.  

"they dont talk english" I believe the phrase you meant "They don't speak english very well".  Must be a regional thing, The CNA's in my area speak very well.

And the last I checked, a CNA/LPN/RN in a nursing home receives monetary compensation for their time and skills which would qualify as a "Real Job"

Again, WOW... Is there a "Most Useless Possible Post" contest that I'm not aware of?


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## ffemt8978 (Nov 2, 2008)

That's enough of this one.


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