First of all, I am a certified EMT, and have been for a few months. I was one of the top in my class, and passed national registry with just a few more than 70 questions, so I’m not stupid. I think I know a lot of the stuff I ask, but I just doubt myself. The main thing I’m wondering about now is what do you do as far as supplemental o2 when the spo2 and presentation don’t match? For example, if there spo2 is 98 but they say they are having difficulty breathing? Do you just assume it’s a psychological thing? I wouldn’t think so. At what point do you determine the pulse ox is incorrect? Or vise versa if they are not complaining of anything, and there spo2 is 82 with a good waveform? Then what?
Supplemental oxygen in relation to Spo2
- Thread starter bdoss2006
- Start date
Effective patient assessment requires a balance between objective/quantitative and subjective/qualitative elements. The degree to which you allow electronic devices to override intuition (or vice versa) involves risks that you can moderate through education and experience.
Consider patient care before widespread availability of pulse oximetry: What we saw, heard, and felt during hands-on exams offered experienced providers generally reliable impressions of O2 saturation -- accurate enough, at least, to set priorities during transport. The tools have changed but not the goals.
Accepting SpO2 values without regard for subjective impressions, or ignoring SpO2 values in favor of subjective impressions, could be dangerous. Use all the information you have and keep learning.
Consider patient care before widespread availability of pulse oximetry: What we saw, heard, and felt during hands-on exams offered experienced providers generally reliable impressions of O2 saturation -- accurate enough, at least, to set priorities during transport. The tools have changed but not the goals.
Accepting SpO2 values without regard for subjective impressions, or ignoring SpO2 values in favor of subjective impressions, could be dangerous. Use all the information you have and keep learning.
Here’s my doubting what I know coming in
what assessment findings would lead you to believe that someone’s spo2 is low even though the monitor says it’s not? Or vise versa, normal when the monitor says it’s low? I’m pretty sure I know the answer to these but I doubt myself1. The device could sense saturation by something other than oxygen.Here’s my doubting what I know coming in
2. The device could be detached or defective, or the patient's perfusion seen by the device could be impeded.
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A person can experience increased work of breathing and the associated anxiety and offer the subjective complaint of "I feel like I can't breathe" while having a normal or near-normal Sp02. An otherwise healthy and fit person can have a pneumothorax or a PE, for instance, but compensate quite well in terms of gas exchange. One of their lungs is essentially not working and they clearly know something feels wrong, but their saturation could still be in the mid or even upper 90's. You see that with less healthy people too, sometimes - a person with COPD can be having an exacerbation but still potentially maintain their Sp02 at or near whatever their baseline is for quite some time. As mgr22 noted, you can also have simple equipment malfunctions or, less commonly, see some sort of toxicity which results in false indications of adequate oxygenation.
Supplemental oxygen is technically not required when someone has an acceptable oxygen saturation. However, keeping the remaining residual capacity well-oxygenated can be useful in terms of staving off decompensation, or at least making that process more gradual and less dramatic than it might be otherwise.
All that said, difficulty breathing is a common complaint among people whose cardiorespiratory system is working just fine. It is usually related to anxiety. Or it could be someone seemingly unrelated like a glycemic problem or electrolyte disorder.
This is where your history and assessment have to work together to gain an accurate picture of what is going on. Has this ever happened to them before? Do they have a history of respiratory problems? Heart problems? Anxiety? Trauma? Recent surgery? Are they tachycardic? Are they at high risk for a PE? What are their breath sounds? Their skin signs? Their general demeanor and affect?
Supplemental oxygen is technically not required when someone has an acceptable oxygen saturation. However, keeping the remaining residual capacity well-oxygenated can be useful in terms of staving off decompensation, or at least making that process more gradual and less dramatic than it might be otherwise.
All that said, difficulty breathing is a common complaint among people whose cardiorespiratory system is working just fine. It is usually related to anxiety. Or it could be someone seemingly unrelated like a glycemic problem or electrolyte disorder.
This is where your history and assessment have to work together to gain an accurate picture of what is going on. Has this ever happened to them before? Do they have a history of respiratory problems? Heart problems? Anxiety? Trauma? Recent surgery? Are they tachycardic? Are they at high risk for a PE? What are their breath sounds? Their skin signs? Their general demeanor and affect?
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As stated above, there are a number of instances when there's a complaint of SOB but still oxygenating well. Most SpO2 sensors that I know of are only capable of determining the percentage of hemoglobin that's bound to something (usually oxygen) or not bound to something. Carbon Monoxide binds VERY well to hemoglobin and doesn't allow oxygen to be carried, so the pulse oximeter could show a very high value but if you were to do an ABG, the actual SaO2 (hemoglobin bound to oxygen) could be dangerously low. People will often feel short of breath and will likely have an excellent SpO2 level and even a great pleth in that instance. If you, by a miracle, had a pulse oximeter that can discern oxygen and CO levels, you'd know if that's the problem. People in DKA can feel short of breath and have an excellent pulse ox/good pleth. They're blowing off ketones and CO2 to try to maintain a good pH. Anxiety is also a big player in people feeling short of breath. So is ventilation... Sometimes people feel short of breath because their body is trying to simply ventilate more... even though oxygenation is fine.
As stated above, you can just blindly put on some oxygen but that doesn't always fix the SOB complaint. If I KNOW the patient is just anxious, I might use medical air through a nasal cannula to provide a feeling of getting additional oxygen. I rarely actually do this but I have done it when the other potential problems have been ruled out and when there's relief with basically getting some room air blown up the nose... However, what I really do is assess the patient to try to determine the cause of the issue and if additional oxygen will be beneficial, or at least of no additional harm.
It can be a good thing to ensure good oxygenation as that can push off/push back a decompensation event. Overoxygenating a patient can be a problem too. So, assessment and evaluation to determine any correctional needs for oxygenation/ventilation is absolutely important.
As stated above, you can just blindly put on some oxygen but that doesn't always fix the SOB complaint. If I KNOW the patient is just anxious, I might use medical air through a nasal cannula to provide a feeling of getting additional oxygen. I rarely actually do this but I have done it when the other potential problems have been ruled out and when there's relief with basically getting some room air blown up the nose... However, what I really do is assess the patient to try to determine the cause of the issue and if additional oxygen will be beneficial, or at least of no additional harm.
It can be a good thing to ensure good oxygenation as that can push off/push back a decompensation event. Overoxygenating a patient can be a problem too. So, assessment and evaluation to determine any correctional needs for oxygenation/ventilation is absolutely important.
Treat the patient not the machine: When I am healthy (relative) and feeling good my SPO2 runs between 88-92%; when my asthma is acting up and I am getting ready to crash hard, I run 98-99%: I think it is because I am working harder to breathe.
At that level very long I will crash, and drop into the 70's%: which has freaked out more than 1 medic and/or ED staff. I have lost consciousness, and come close a few times to being intubated, but so far haven't. But I come back fast if I get albuterol or a DuoNeb bagged in.
Ask your patient, if they feel short of breath help them. May just take a NC, I have had a couple of patients feel better with the NC on them, not hooked up to O2, 1 it needs to be on the tree, but not turned on.
O2 is relatively inexpensive (except switching tanks)
At that level very long I will crash, and drop into the 70's%: which has freaked out more than 1 medic and/or ED staff. I have lost consciousness, and come close a few times to being intubated, but so far haven't. But I come back fast if I get albuterol or a DuoNeb bagged in.
Ask your patient, if they feel short of breath help them. May just take a NC, I have had a couple of patients feel better with the NC on them, not hooked up to O2, 1 it needs to be on the tree, but not turned on.
O2 is relatively inexpensive (except switching tanks)