Pulse Ox?

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AShaddeau

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Is this correct? Wouldn't you use a BVM for a pt that is having difficulty breathing?

3.Apply oxygen devices as you normally would without the benefit of a pulse oximeter reading.
Patients who exhibit difficulty breathing, or any signs of circulatory difficulty, should receive high-flow oxygen via non-rebreather mask, regardless of oxygen saturation readings. :unsure:

http://www.wmems.org/pulseox.html
 
I'm not exactly sure what you're asking.... Could you rephrase it a little better?
 
AShaddeau said:
Is this correct? Wouldn't you use a BVM for a pt that is having difficulty breathing?
Click to expand...

The difference between difficulty breathing and apneic in need of positive pressure ventilation could be boiled down to this: if they can't breathe on their own, BVM. If they're breathing, but, say, have difficulty breathing (i.e. are saying "I can't breathe"), an NRB would be indicated.

This being said, you can (and ought to) ventilate (with a BVM) a patient who is breathing but less than 8 or more than 24 respirations per minute.

Pulse oximetry is a tool -- don't ignore the patient. If the patient says they're having trouble breathing but the SpO2 is 99%, they very well may be having a problem -- consider O2.

NB: Pulse ox is not always accurate: think Cyanide poisoning, say.
NB (2): Remember that it is NOT a measure of respiratory status, not fully, it only measures oxygenation.
 
Depends on the level of respiratory distress. Some patients need some ventilatory assistance if their rate or depth is inadequate and they don't appear able to maintain adequate ventilation on their own.

Essentially what the paragraph you quoted is saying is "treat the patient, not the SPO2 monitor." Given the information in that paragraph, the opposite argument could be made for patients showing low or normal SPO2 readings, yet lack outward signs and symptoms. That is to say, patent are not required to get oxygen simply by virtue of having an ambulance arrive at their home. The decision should be made based on clinical observations, which may or may not include SPO2 readings.

So if you want a terribly simplistc overview of the concept, for which their are likely multiple exceptions, here you go:

Use an NRB, NC, or other non-assisting device for patients who can breathe,(ventilate) but are not oxygenating well.

Use a BVM and adjuncts if appropriate and necessary for patient who can't ventilate.
 
AShaddeau said:
Is this correct? Wouldn't you use a BVM for a pt that is having difficulty breathing?

3.Apply oxygen devices as you normally would without the benefit of a pulse oximeter reading.
Patients who exhibit difficulty breathing, or any signs of circulatory difficulty, should receive high-flow oxygen via non-rebreather mask, regardless of oxygen saturation readings. :unsure:

http://www.wmems.org/pulseox.html
Click to expand...

There are many different levels of, "Difficulty breathing." One the one hand you have the asthmatic might be managing his asthma fine but has since run out of his nebulized medications. He becomes anxious, dials 911, and may have some mild wheezing. Is he short of breath? Absolutely. Does he need to be bagged? Nah. He's 126/78 RR 22 no accessory muscle use noted. Maybe your protocols allow for you to throw him on a breathing treatment and he clears right up. A BVM would be overkill here and wouldn't fix the reactive airway. The patient needs a beta agonist to open up his airways.

Then on the opposite end of the spectrum you have a 65 year old male with SOB x1 day, lower extremity edema, distended abdomen, 240/145 HR125 BP 40RR bilateral wheezes and crackles throughout, tripodding, and using accessory muscles. This guy is really short of breath and could use some positive pressure ventilation.

It's all about your assessments. That's what this is trying to get across. The pulse ox is a tool but without knowing his o2 sat you can see the difference between the critical CHF patient and the asthmatic in mild distress. Sometimes the pulseox is wrong or reads a normal reading. It's those times where you have to look at the patient as a health care provider and think, "Ok, is he in distress or not and what do I have to do to fix it?"
 
Frozennoodle said:
There are many different levels of, "Difficulty breathing." One the one hand you have the asthmatic might be managing his asthma fine but has since run out of his nebulized medications. He becomes anxious, dials 911, and may have some mild wheezing. Is he short of breath? Absolutely. Does he need to be bagged?
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Interesting side not on this scenario...this patient likely would not benefit from bagging, and it may exacerbate the issue. Asthmatics have lower airway obstruction issues, and hence trap air.

Asthmatics have trouble exhaling, not inhaling.
 
The pulse ox does not measure tissue perfusion, it measures the saturation of one red blood cell. If you have a low spo2 and labored breathing, treat accordingly. If you have a high spo2 and labored breathing, treat the patient, not the number, if you have a high spo2 and no cyanosis/complaints of shortness of breath, safe to say you're ok.
 
WTEngel said:
Interesting side not on this scenario...this patient likely would not benefit from bagging, and it may exacerbate the issue. Asthmatics have lower airway obstruction issues, and hence trap air.

Asthmatics have trouble exhaling, not inhaling.
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I was going to add that in but was having trouble framing it in my head so I just skipped it. Thanks!
 
Good thoughts

Where I work, we all seem to call it "O2 sat" and not "pulse ox" must be an Indiana thing.
 
This being said, you can (and ought to) ventilate (with a BVM) a patient who is breathing but less than 8 or more than 24 respirations per minute.
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I think that this only holds true for testing scenarios. In real world situations the decision to ventilate is usually base on depth and level of consciousness.

I've had plenty of adults with resps in the 30s or higher who've been alert and moving decent volumes. BVM assisted ventilation is quite difficult without sedation, and carries its own risks.
 
Mariemt said:
A "pulse Oximeter " reads "O2 Saturation"

I am digging the quotes
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Corrections. a pulse oximeter measures oxygen saturation.


Side question... why is "pulse oximeter" in quotes?
 
Has anyone seen the new "pulse ox like" device that reads svo2?
 
JPINFV said:
Corrections. a pulse oximeter measures oxygen saturation.


Side question... why is "pulse oximeter" in quotes?
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Semantics

I don't know I was just following the lead. We all shall use quotes. ;)
 
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Mariemt said:
A "pulse Oximeter " reads "O2 Saturation"

I am digging the quotes
Click to expand...

This is not entirely true. An Pulse Oximeter is measuring the hemoglobin content, it can not determine whether it is Carbon-monoxide or Oxygen. CO has an affinity 250 greater than O2.
 
ffjosh said:
This is not entirely true. An Pulse Oximeter is measuring the hemoglobin content, it can not determine whether it is Carbon-monoxide or Oxygen. CO has an affinity 250 greater than O2.
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It's measuring hemoglobin saturation... not hemoglobin content (that would be a CBC).
 
Get an EtcO2 in conjunction with SpO2. Or just go with the EtCo2 instead. I like it more.
 
BeachMedic said:
Get an EtcO2 in conjunction with SpO2. Or just go with the EtCo2 instead. I like it more.
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Best rationale ever. Don't even use pulse oximetry. I don't like it.
 
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