Pulse ox and upgrading

vcuemt said:
"Let's head on out... lights and sirens, nice and easy," is how I've heard that before.
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That's the only way I ever request L&S, and rarely at that.
 
Jason said:
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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You know, except response to treatment. If oxygenation improves and the clinical picture doesn't, then you have a second problem someplace that needs to be found.
 
vcuemt said:
"Let's head on out... lights and sirens, nice and easy," is how I've heard that before.
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The Boston area is fond of the "easy 2."
 
Chewy20 said:
Maybe I should have said in heavy traffic, both cities I have been in would take about 30 minutes to go two miles for the majority of the day if it were not for lights and sirens. You may get mad at your partner for going through an intersection, but if you come to a red light at an intersection and STOP, eventually people will stop after seeing you from all other 3 streets and then it would be safe to proceed at a slow speed. I don't know who your partners are but it sounds like you have been thrown around in the back of the box a lot and don't trust their driving. If the pt is stable (like most are) than no they may not be going into the ER with sirens blaring, but I have zero problem with going through a city or highway with them on.
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When I say opposing I meant in opposing lanes of traffic, not intersections. Sorry for the confusion.
Brandon I still disagree with you. If you're having to transport lights and sirens for symptom relief that's a failure on the part of your system. There's no excuse for that whatsoever. There's nothing you can say to make it not dangerous. Sure driving safely you reduce the risk but there's still an increased risk using red lights and sirens. People do dumb **** around emergency vehicles when they aren't going emergent. Add in the disco lights and the wee woos and it gets even worse.
 
JPINFV said:
You know, except response to treatment. If oxygenation improves and the clinical picture doesn't, then you have a second problem someplace that needs to be found.
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Yep. Heck, I look for those anyway because sometimes the problem you see might cause you to miss the other one....
 
Akulahawk said:
Yep. Heck, I look for those anyway because sometimes the problem you see might cause you to miss the other one....
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To quote Atlas Shrugged (I'll take useful quotes where ever I can find one), "I'll give you a hint. Contradictions do not exist. Whenever you think that you are facing a contradiction, check your premises. You will find that one of them is wrong."
 
JPINFV said:
To quote Atlas Shrugged (I'll take useful quotes where ever I can find one), "I'll give you a hint. Contradictions do not exist. Whenever you think that you are facing a contradiction, check your premises. You will find that one of them is wrong."
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That is a great quote from a great book. Signature-line-worthy, even....
 
Handsome Robb said:
Brandon I still disagree with you. If you're having to transport lights and sirens for symptom relief that's a failure on the part of your system. There's no excuse for that whatsoever.
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I agree about system failure, but it's unfortunately a common one. I'll be happier when medics everywhere can be relied upon to provide palliative measures if called to intercept for a non-life-threatening complaint, and even happier when BLS units can offer appropriate meds themselves. But until then, I think relieving suffering is as good a reason for safely expedited transport as any, and better than most.

Cure seldom, relieve often, comfort always.
 
Personally I run about 90% when I am breathing fine; and abou 96-98% when I am having major issues (asthma). So if you go by the numbers I don't need any O2 or a neb treatment. And I have had people refuse to give me help (and one medic took my Neb tx away when I was using my own tubing and Albuterol and just using company O2: Cause my numbers were too good and I wasn't wheezing)
 
johnrsemt said:
Personally I run about 90% when I am breathing fine; and abou 96-98% when I am having major issues (asthma). So if you go by the numbers I don't need any O2 or a neb treatment. And I have had people refuse to give me help (and one medic took my Neb tx away when I was using my own tubing and Albuterol and just using company O2: Cause my numbers were too good and I wasn't wheezing)
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Huh? Do you have COPD too, or just the asthma?
 
gonefishing said:
Treat the patient not the machine.
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Treat both until you have a damn good reason not too (equipment failure, multiple false readings, etc).
 
Underoath87 said:
Huh? Do you have COPD too, or just the asthma?
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It's not that unusual. I tend to run about 92 when I'm at rest. Unless I'm moving or talking, I generally only breathe four or five times a minute. Add that to being a heavy sleeper, and I've more or less accepted that I will eventually be woken from a nap by someone trying to ventilate me.
 
shademt said:
In regards to assessing oxygen saturation via an electronic pulse oximeter and taking into account the other vital signs, at what percent O2 would you consider upgrading the call to code 3 or ALS?

Thanks for the feedback
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I hate to sound like broken record and drop the whole "Treat the patient, not the monitor" line but it couldn't be more true. In fact, there are often times when you don't want patients to be at 100% and many protocols dictate to titrate lower.

On a side note, if you are upgrading based on pulse ox alone, look closer... Odds are, if the patient truly needs ALS interventions, there are other s/s that will cement your decision to upgrade.
 
MedicD said:
I hate to sound like broken record and drop the whole "Treat the patient, not the monitor" line but it couldn't be more true. In fact, there are often times when you don't want patients to be at 100% and many protocols dictate to titrate lower.

On a side note, if you are upgrading based on pulse ox alone, look closer... Odds are, if the patient truly needs ALS interventions, there are other s/s that will cement your decision to upgrade.
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I hit 91% during my asthma attack, and it sucked. Pulse ox is a great tool.
 
im sure its been said but if your patient has rales, is cyanotic and can barely speak let alone breathe who cares what their sp02 is? are you going to delay treatment to get a number back? its nice to have but shouldnt be the deciding factor.
 
Angel said:
im sure its been said but if your patient has rales, is cyanotic and can barely speak let alone breathe who cares what their sp02 is? are you going to delay treatment to get a number back? its nice to have but shouldnt be the deciding factor.
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Put the probe on and then start treating them! Getting everything set up and doing auscultation is going to give the probe enough time to get a reading.
 
gronch said:
I hit 91% during my asthma attack, and it sucked. Pulse ox is a great tool.
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I've had some doozy asthma attacks while on call, one at a fire stand-by.. My partner offered me an Aero-neb, I declined, he offered manual exhalation assistance.. I told him to stop dreaming, he's not touching my b**bies. Good ol Proventil works everytime..

I had just started out, and we responded to a 2 car wreck on a MN roadside in January. One pt was sitting on the side of the road, I did my assessment, his sats were running low 70's.. Green little Probie me says, "OMG, medic, we need to get him on an NRB!" Medic comes over, introduces himself, shakes the guy's hand, asks him a couple questions. Says to me, "He's fine" Grabs the guy a heat pack from the rig for his freezing fingers that I tried to take a sat reading from. Well...

Experience noted, squirreled away in my brain for future reference. Patient exhibited zero symptoms of hypoxia, but in my inexperience, all I saw was the saturation.
 
If you're using the pulse ox to decide if you need ALS, you're already too late.

EDIT: Oh... This is already on page 6. Oops.
 
I think its nice to have one but dont rely solely on it.Like others have said look at the big picture with the other vital signs.
 
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