Pulse Oximeter and EMT-B

[rhan101277]

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?

 

[Flight-LP]

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................

 

[Buzz]

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.

 

[rhan101277]

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.

 

[KEVD18]

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....

 

[mycrofft]

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!!

 

[VentMedic]

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.

 

[KEVD18]

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.....

 

[Hastings]

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.....

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.

 

[VentMedic]

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.

 

[KEVD18]

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.

 

[VentMedic]

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

 

[mycrofft]

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

 

[MSDeltaFlt]

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

 

[rhan101277]

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.

 

[KEVD18]

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.

 

[mikie]

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

 

[Flight-LP]

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?

 

[MSDeltaFlt]

Sssssshhhhhh!!! they think we were dodging storms.

 

[Flight-LP]

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

Keep it safe!