Pulse Oximeter and EMT-B

[Mongoose]

Re: Pulse Ox and EMT-B

Here in California we can use them. Some of our "Ricky Rescuer" EMT's actually go out and shell out $300+ for a pocket PulseOx that is horribly unreliable anyway.

In my opinion it is more of a nicety than anything else. My recommendation: Use your general impression right when you first establish contact to determine if the pt needs o2. If the general impression isn't a good enough indicator typically you will know by the time you've assessed their alert status and gotten the chief complaint.

 

[marineman]

We carry them but I could probably count the number of times I used it on one hand. 95% of the time you can get a good enough idea just by looking at the patient. Like was mentioned sometimes it's good to get hard numbers for the effectiveness of your treatment but too many people get in the habit of hooking it up every time and treating the machine.

I can't believe how different some protocols are throughout the states. Up here our first responders have been doing combitubes for several years now.

 

[traumateam1]

We are allowed to use there here in BC at my level. I use them and don't mind them. However keep in mind. Treat the patient, not the machine.

 

[JPINFV]

Here in California we can use them.

Depends on which county you are in.

 

[TheMowingMonk]

Yeah here in Santa Clara County if your in the county system your not allowed to use them. I like having the reading from it though, cause like every nurse asks for what it was when we pick them up (even if they already know we are a BLS unit and cant take them) so to fix it if were doing our usual IFTs ill ask the nurse or the CNA to take one right before we go, and if they are warm or anything i usually get a temp from them too (Since like pulse ox taking a tempurature is too much for an EMT in santa clara county. but not to much for joe shmoo.....) anywho i think alot of the restrictions on EMTs are rediculus but thats my own rant. but point is JPINFV is right, its a county by county thing even though according to title 22 for california law it is legal on the state level.

 

[Scout]

They are great for kids.


Slap it on and get them to make the pulse number as low as possible, treat it as a game.


Works wonders to calm them down. That and on long transports where i'm filling in every field on the PCR and chatting away with the Pt. only times i have used them.

 

[pumper12fireman]

I'm not a huge fan of pulse ox in the field. In EMT school it sounded like a great idea, but in actual practice I rarely use it to decide whether or not to place a pt. on O2. I use it to fill in the little box on the report. Or, to help determine how well a certain tx is working. It also doesn't seem to work on older people, people with a bradycardia, people with any kind of fingernail polish, and the numbers love to jump around in the back of a moving ambulance. I think color, mental status, and other factors are much more concrete in deciding a treatment plan.

 

[EMTDON970]

I have my own Pulse Ox (dont ask), I use it often, but again I treat my patient, not the machine.

 

[Jon]

I'm not a huge fan of pulse ox in the field. In EMT school it sounded like a great idea, but in actual practice I rarely use it to decide whether or not to place a pt. on O2. I use it to fill in the little box on the report. Or, to help determine how well a certain tx is working. It also doesn't seem to work on older people, people with a bradycardia, people with any kind of fingernail polish, and the numbers love to jump around in the back of a moving ambulance. I think color, mental status, and other factors are much more concrete in deciding a treatment plan.

Yep.


I really want to take it away from the new EMT's at my squad. When I start precepting officially - I plan on asking the preceptee to be able to JUSTIFY why they want the pulse ox.

I enjoy rocking the boat occasionally.

 

[Foxbat]

How does O2 amninistration helps if pt. truly has 100% SpO2? If the problem is in poor blood circulation or O2 absorption by tissue rather than in % of hemoglobin attached to oxygen, why would increasing O2 content in inhaled air help? I obviously would give O2 to pt. in respiratory distress with 100% SpO2, I am just curious why.

 

[flhtci01]

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.

Recently had a nursing home SOB. They stated pulse ox was 27 before our arrival. They had the pt on 2 lpm NC SpO was 88. The 27 was a good laugh in the ER. Remember 'Trust but verify'.

 

[VentMedic]

Recently had a nursing home SOB. They stated pulse ox was 27 before our arrival. They had the pt on 2 lpm NC SpO was 88. The 27 was a good laugh in the ER. Remember 'Trust but verify'.

Why the laugh? That actually can be possible. A little stimulation and O2 can bring someone back from an SpO2 like that. If anyone has ever worked in an ICU or observed babies, they would know this. Granted it does take matching the patient and machine, but that is a very possible situation. Pulse Ox machines do loose their accuracy at lower saturations so it is difficult to tell what the actual SpO2 is below 75%. Some COPD patients drop their SpO2 like a rock but bounce right back with 2 L. It all depends on where their oxyhemoglobin dissociation curve lies.

 

[traumateam1]

"Treat the patient, not the machine"
How was this SpO2 of 27 p/t breathing while at 27. Was there cyanosis, or severe SOB or difficulty breathing? If so than 2 Lmp NC is obviously a horrible way to treat the p/t. However if they are breathing fine and just a little low on the SpO2 monitor than I guess you could give 2 Lmp. PERSONALLY (depending on p/t hx) I would give them higher flow O2 just to bump their SpO2 to low 90's at least. However 88 isn't bad.

 

[Ridryder911]

It all depends on where their oxyhemoglobin dissociation curve lies.

Now come on Vent... Your talking old school now! I doubt very few Paramedics know what that is...

R/r 911

 

[traumateam1]

YEAH! Lets keep this simple easy words now Vent. What's wrong with you?!?
No just kidding, but when I see something like that that I have no idea what it is I go and Wiki it, and the Google it if Wiki doesn't have anything on there.. great way to continually learn!

"The oxyhemoglobin dissociation curve is an important tool for understanding how our blood carries and releases oxygen. Specifically, the oxyhemoglobin dissociation curve relates oxygen saturation (SO2) and partial pressure of oxygen in the blood (PO2), and is determined by what is called "hemoglobin's affinity for oxygen," that is, how readily hemoglobin acquires and releases oxygen molecules from its surrounding tissue."

 

[marineman]

Now come on Vent... Your talking old school now! I doubt very few Paramedics know what that is...

R/r 911

You're right, but just because you said that I googled it B)

 

[VentMedic]

A few of the things you should know about oxygen:

http://www.ccmtutorials.com/rs/oxygen/index.htm

 

[traumateam1]

And this is why we LOVE you Vent.
You have information for everything that any of us at any time have a question for. Thank you for the link.. gonna read it and learn something new! Woohoo lol.



Sorry everyone.. a little hyper tonight. But really Vent, we LOVE you!

 

[VaEMT66]

I can understand your frustration. We use the LIFEPAK-12, and our protocols allow its use. However, the county next to us, is not allowed to use it, nor are they allowed to automatically give glucose to a diabetic patient. They have to call the their local hospital and ask for permission.

Jeff

 

[Jon]

Are you a BLS or ALS service? At the BLS level, what are you using a Lifepak 12 for?