Did I do the right thing?

Fezman92

Fezman92

NJ and PA EMT
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So I’m doing a BLS transport for a guy on O2. We left the hospital and all of his vitals were good. I get him in the ambulance and check his SPO2. It’s 87/88. I bump him up to 6L O2 via NC (he was on 2L via NC at the hospital), wait a few minutes, only goes up to 89-91. Check both fingers, same results. Call ODS to let them know what’s going on and that I’m going to put him on an NBR. They tell me to have my partner turn around and go back to the hospital since I’m increasing the level of care and to put him on the NBR. I put him on the NBR at 10L. SPO2 shows 95% We turn around and get back to the ED. ED Checks him out and says he’s ok to go back on a NC. This entire time there was nothing visibly wrong with the PT, no cold extremities, trouble breathing, etc. Did I over react to what’s most likely a bad reading from crummy equipment?
 
There are many different reasons for low SPO2 readings. Got some patients we actually want readings of 88-92%.

Does your pulse oximeter display a plethysmograph? Do some research on reading one and it will help you understand accuracy of readings.

It sounds like you're lacking in experience so I don't think you were that out of line in making sure the patient was okay. This can be a lesson to check vitals in the hospital before you leave.
 
What's his baseline SPO2?

What's ODS?

Could this be a case of "treat the patient not the monitor?"
 
DrParasite said:
Could this be a case of "treat the patient not the monitor?"
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Yeah in retrospect I ended up treating the equipment not the PT. I feel like a fool going back to the hospital just to be sent back to where we were going. Especially since I’m working on going back to 911, this doesn’t make me look like an EMT who knows what he’s doing. Granted the last part could just be me being too critical of myself.
 
Well at times....
 
In all seriousness I've never had a problem with ODS. They’re just as overworked as anyone else at work. It’s very common to have them out doing calls, either the 911 side in NJ or the transport side in PA.
 
Fezman92 said:
Yeah in retrospect I ended up treating the equipment not the PT. I feel like a fool going back to the hospital just to be sent back to where we were going. Especially since I’m working on going back to 911, this doesn’t make me look like an EMT who knows what he’s doing. Granted the last part could just be me being too critical of myself.
Click to expand...
My previous comment aside, did the patient have a potential issue? had you transported the patient to the SNF, with a SPO2 in the 80s, would the SNF have accepted the patient? Or would they have refused, because the patient was too "unstable" for them to manage, and you would need to bring them back to the ER anyway?

From my own experience, I was once transporting a patient from my home ER back to a group home. pt has a known seizure hx (I think he had a brain tumor, I don't remember exactly). the patient seemed stable, vitals good, etc. We leave the ER, for a nice easy ride 20-30 minutes away. it's a nice day, clear skies, etc. and 5 minutes after we clear the ER, he starts seizing, Would he have stopped on his own? probably; but I didn't have any way to guarantee that. condition changes, the patient is unstable (because I can't treat an actively seizing patient). when we got back to the ER, Doc asks why this patient is back, because he just discharged him, and we explain "he started seizing." He wasn't thrilled, but at the end of the day, we all have to do our jobs.

I've always said, I have no problem punting to a more educated provider, or erring on the side of looking like a fool when I am doing what I think is in my patient's best interest. If the other provide wants to chat with my boss about it, won't be the first time, and won't be the last: at the end of the day, I am still going to err on the side of what I think is in the patient's best interest. You consulted your ODS, who said to head back to the ER; I wouldn't lose sleep over this particular issue.
 
He had pneumonia due to COVID-19 and had to be transported by BLS because he needed to be on O2.
 
I don't think you did the wrong thing. Flipping on L&S and speeding to the closest ED would have been doing the wrong thing. Requesting an ALS intercept would have been doing the wrong thing. Calling your supervisor for advice on handling a situation that you aren't sure about is almost never the wrong thing. Erring on the side of patient safety when you aren't sure about something is never the wrong thing.

A pulse oximetry of 87% on oxygen is not something to ignore, and the fact that increasing the Fi02 improved the SP02 is not reassuring. Absent correlating clinical signs, it is more likely an equipment issue than a clinical one, but we have monitors for a reason, and it wouldn't be the first time in history that a change on the monitor preceded a clinical change. It could have just been the stress of movement. Someone who has had a pneumonia of sufficient severity to require hospitalization and then rehab will tolerate a much lower Sp02 before showing signs of respiratory failure because, to put it simply, they are used to it. Did his HR increase at the same time the SP02 decreased? Was he on beta blockers? Any cardiac issues? Previous stroke? What was his hemoglobin? You probably don't know the answers to those questions and that's fine, I'm just making the point that you had limited information to go on and are limited in your ability to interpret that information even if you did have it.

I would expect an experienced clinician to handle a situation like this differently, but someone with your level of training and experience, I'm not sure what else should be expected.
 
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