Pulse ox

[Gordoemt]

Can an emt in los angeles county use a cheapo pocket pulse ox on a bls rig?

 

[DesertMedic66]

If pulse ox is in your scope of practice. If its not in your scope then no.

 

[tnoye1337]

In our rigs we have a moniter that does BP, HR, o2 sat, and a bunch of other things. In NY we're allowed to do o2 sats as basics.

 

[JPINFV]

There's 2 different questions here.

1. Can an EMT in LA gather and interpret pulse oxymetry?

2. Can an EMT use their own cheap finger probe to do so?

For 1, I would argue yes. Given what is listed on the LA LEMSA website regarding scope of practice, they largely appear to copy the state scope of practice, which includes the following line, "C. Obtain diagnostic signs to include, but not limited to, the assessment of temperature,blood pressure, pulse and respiration rates, level of consciousness, and pupil status."

Emphasis added.
- http://ems.dhs.lacounty.gov/policies/Ref800/802.pdf

So how far can you legitimately stretch the "but not limited to" clause? Does it not make sense to give EMTs access to non-invasive monitoring for one of the interventions that they can provide (i.e. supplemental oxygen)?


2. If you supply your own equipment, you're responsible to ensure that it is properly maintained and calibrated. I don't know if I would want to, day in and day out, rely on a 30 dollar drug store pulse ox to make medical decisions.

 

[Melclin]

You can't ask a clinical manager or medical director these questions?

 

[rwik123]

To me pulse ox is just another vital sign that all basics should be able to assess. It's one of the first thing I slap on the patient when coming on scene. It takes half a second and gives me a baseline. What's the reasoning for not allowing it in some basic scopes?

 

[NomadicMedic]

Sounds like somebody wants to buy a new toy.

If its supplied on your rig, you most likely don't need it. Contrary to what many think, even a pulse ox requires a biomed calibration every year (or more frequently).

If you want to spend money, take classes.

 

[JPINFV]

What's the reasoning for not allowing it in some basic scopes?

...because people would rather use stupid outdated cliches like "everyone needs oxygen" or "treat the patient not the machine" than teach clinical reasoning and trouble shooting.

 

[Melclin]

To me pulse ox is just another vital sign that all basics should be able to assess. It's one of the first thing I slap on the patient when coming on scene. It takes half a second and gives me a baseline. What's the reasoning for not allowing it in some basic scopes?

It can give people a false sense of security. A SpO2 of 98% does not a healthy respiratory pt make. Similarly, 78% doesn't mean you're sick. It might just mean you have nail polish on, or that the sensor isn't seated properly. I've been to quite a few nursing homes where a nurse has popped the pulse ox on a pt for daily obs and found it to be 94 after looking at it for only a few moments. We get called for a "desat" and you get there to find a pt on 3LPM via a non re-breather.

It can be dangerous to collect information if you don't really understand what that information means.

That said, as part of a 911 ambulance service, I think SpO2 is quite important. If people don't know how to use then, they need to be taught.

 

[rwik123]

It can give people a false sense of security. A SpO2 of 98% does not a healthy respiratory pt make. Similarly, 78% doesn't mean you're sick. It might just mean you have nail polish on, or that the sensor isn't seated properly. I've been to quite a few nursing homes where a nurse has popped the pulse ox on a pt for daily obs and found it to be 94 after looking at it for only a few moments. We get called for a "desat" and you get there to find a pt on 3LPM via a non re-breather.

It can be dangerous to collect information if you don't really understand what that information means.

That said, as part of a 911 ambulance service, I think SpO2 is quite important. If people don't know how to use then, they need to be taught.

Agreed. Generally from my experience spo2 has been generally accurate 99% of the time. Of course you need to weigh your clinical judgment in turn with the readout and not use cookbook medecine by not treating the number. Another thing to keep in mind are CO patients. They may read like they are sating normal but are not in reality.

 

[Melclin]

Agreed. Generally from my experience spo2 has been generally accurate 99% of the time. Of course you need to weigh your clinical judgment in turn with the readout and not use cookbook medecine by not treating the number. Another thing to keep in mind are CO patients. They may read like they are sating normal but are not in reality.

Yup. Not saying an EMT can't do that. I'm sure they can and they should be taught how. I agree with you. SpO2 is basically a vital sign nowadays.

But I think trouble starts when an EMT goes to walmart and buys a $29 pulse ox with the lose understanding that lower numbers are bad and then proceeds to ignore more important signs of respiratory status while they fiddle with their new toy, which is sort of what the OP seemed to be suggesting.

 

[jjesusfreak01]

I carry a $60 pulseox identical to the ones my company provides (and does not calibrate). It doesn't really make sense that you could limit the use of a non-invasive diagnostic tool. I pretty much just use it on my respiratory patients to make sure they maintain well during transport. Obviously their general appearance, other vitals, and breath sounds are equally important to their sat values.

 

[BearChicago]

Our Chicago SMOs say to use pulse ox "if available" in certain situations. Most privates in town refuse sink money into them at the BLS level, and I'm not buying my own. Seems kind of stupid, because most EDs want a SPO2 on room air and on O2.

 

[Akulahawk]

If you can show/document that you were properly in-serviced/educated in the use of the SpO2 devices, including troubleshooting them and factors that can confound them, and use of that tool is authorized (or at least excluded from) as part of your scope of practice for your level, then yes, you should be able to use the SpO2. Whether or not you also want to take on any additional liability for maintaining them, that's up to you.

Now since your employer may be at least somewhat responsible for your clinical actions, they may also have a say in what you can use while you're "on the clock."

 

[jjesusfreak01]

If you can show/document that you were properly in-serviced/educated in the use of the SpO2 devices, including troubleshooting them and factors that can confound them, and use of that tool is authorized (or at least excluded from) as part of your scope of practice for your level, then yes, you should be able to use the SpO2. Whether or not you also want to take on any additional liability for maintaining them, that's up to you.

Now since your employer may be at least somewhat responsible for your clinical actions, they may also have a say in what you can use while you're "on the clock."

It would seem the alternative though is to either just make clinical decisions without pulse oximetry or to make no decisions at all and put everyone on 15lpm NRB. In the end, without a means to determine sats, every respiratory, cardiac, overheated, or generally sick looking person is going to get 15 lpm, and we know that actually causes harm when it isn't indicated. I suppose I agree with you, its just annoying.

 

[Akulahawk]

I used to make clinical decisions about O2 all the time... without the "benefit" of the SpO2. I still make them that way, actually. I use the SpO2 to (more or less) confirm what I'm seeing and as a tool to quantify response to tx.

Oh, yeah, it's very annoying to me that sometimes we're required to put a patient on 15LPM because protocol says so... and there's no room for exercising clinical judgment. (Just one small example.)

 

[mycrofft]

Using your own instrumentation is foolish. If something goes wrong, the company washes their hands of you. And you will not have the certified maintenance needed, or want to replace the >$100 leads that the real one seem to demand.

Exactly WHAT does a pulse-ox do except make reassuring or alarming beeping sounds? And how does putting one on a pt make sure they are in good shape? (I know the practical answers, but have heard many magical explanations over the years, want a few more).

PS: I remember a few years a go here that everyone swore by them; now, not so much.

 

[hogwiley]

Regardless of the usual high and mighty your just a silly little EMT who cant possibly be trusted to understand that a pulse ox reading isnt always reliable, I think they are useful tools and dont see any point in denying someone the ability to use one. I work in a hospital and I use them on patients constantly all shift long. Can they be wrong? Once in a blue moon youll get a reading that doesnt seem right, but its rare. More often you simply wont be able to get any reading due to poor circulation, or the previously mentioned nail polish.

Now getting a skewed reading on a Temporal thermometer is far more common, but thats another story.

 

[Christopher]

Basically, with a good waveform you can trust SpO2%. Without a good waveform, you cannot trust SpO2%.

So, if your device will not show you the waveform associated (or doesn't have some index or meter to display the quality of the flow it is reading) then you cannot trust the numbers.

 

[DrParasite]

Was on the ambulance a few weeks ago, with me, a new guy, and a 10 year veteran/past captain of the organization, and asked the new guy to get vitals. the past captain told the new guy to just throw the patient on the pulse ox to get a pulse rate. and finding that it was missing, the new guy was unsure how to proceed.

I told him if I ever ask him to get to get vitals, and he reaches for the pulse ox, I am going to hit him in the head with the metal clip board.

Now if someone wants to get manual vitals, and use the pulse ox to monitor pulse rates and PO2 during the transport, fine.

then again, I think those would always complain about using technology for assessments (autocuffs for BP, cardiac monitor and pulse ox for RR) but think it's ok that the ERs and hospitals (and even some paramedics) do this all the time are major hypocrites.