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cointosser13

cointosser13

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I recently found out that my Lifepack 15 can measure CO levels. First of all, how does it do that? I knew the Lifepack could measure SpO2 levels and Capnography, but not CO levels. Does anybody know what the Lifepack would show for CO levels for a normal person (for example normal levels for SpO2 levels would be 97%-100%)? I know we inhale a certain amount of CO normally which doesn't effect us, but if it's a lot a person can start having a headache.
 
It works basically the same way that SpO2 works, it just uses a different wavelength of light that, to simplify greatly, fluoresces with CO. The masimo rainbow actually does a whole bunch of different things with the same probe.

As far as what normal limits are, that's a pretty hard question to answer. It depends on a whole bunch of environmental factors, but as a quick and dirty guideline, anything under 10% isn't worth panicking about, anything under 5% should be very well tolerated by the majority of the population.

That being said, I personally don't really believe in CO monitoring in a prehospital setting, ultimately, if there's a danger of CO poisoning, you should have that from your MOI and your s/s, and what are you going to do about it? Apply O2 and diesel, nothing's going to change based on knowing your pt's CO level, so why bother?

The only argument I can possibly see for it is if you're working rehab, and there's a policy in place for "Anyone with a SpCO over x% can't go back in."
 
cointosser13 said:
I recently found out that my Lifepack 15 can measure CO levels. First of all, how does it do that? I knew the Lifepack could measure SpO2 levels and Capnography, but not CO levels. Does anybody know what the Lifepack would show for CO levels for a normal person (for example normal levels for SpO2 levels would be 97%-100%)? I know we inhale a certain amount of CO normally which doesn't effect us, but if it's a lot a person can start having a headache.
Click to expand...

Not all LifePaks do it, its only available on the 15, and as an option ( for an extra $5k or so). I think it does have value, if nothing else for identifying unexpected CO exposures (although there are less expensive ways).

For what its worth, a few fire departments in my area claim they've found high co levels in many apartments when on unexpected calls (flu symptoms, abd pain), by placing CO meters on their bags, and all without a $5000 oximeter. Some departments have bought one standalone CO oximeter for supervisor trucks or fire rehab, but DOnt use on every patient.
 
Our supes have them and respond to calls that sound like they'd be needed or useful and also as requested.

0-5% is considered normal in the non-smoking population.
5-10% is considered normal for smokers and for patients with certain disease processes.
>10% is considered abnormal.

The probes are finicky. They can be sensitive to temperature and definitely light. There is a hood that comes with all of ours that you place over the patient's finger/hand after placing the probe to place it in complete darkness. I'm not sure if it's specific to our monitors but considering it uses certain wavelengths of light I'd assume all are affected.
 
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UnkiEMT said:
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The only argument I can possibly see for it is if you're working rehab, and there's a policy in place for "Anyone with a SpCO over x% can't go back in."
Click to expand...

Such guidelines are out there, but they are not backed up by convincing evidence. The NFPA rehab guidelines suggest that a firefighter not be released from rehab if their CO level exceeds 15%. Problem is, the best study out there showed that the RAD-57 devices are less than 50% sensitive for the 15% threshold.

In other words, flipping a coin in triage would be just as accurate, and far cheaper. Not sure how safe, though.

Performance of the RAD-57 pulse CO-oximeter compared with standard laboratory carboxyhemoglobin measurement.
 
If that's a link it no worky, Doc.

Edit: it works online just not on tapatalk.
 
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Yea, I smarted up and figured it out.

That's pretty interesting. I bet my employer wouldn't be stoked to see that after spending like 15-20 thousand dollars on them recently.
 
KellyBracket said:
Such guidelines are out there, but they are not backed up by convincing evidence. The NFPA rehab guidelines suggest that a firefighter not be released from rehab if their CO level exceeds 15%. Problem is, the best study out there showed that the RAD-57 devices are less than 50% sensitive for the 15% threshold.

In other words, flipping a coin in triage would be just as accurate, and far cheaper. Not sure how safe, though.

Performance of the RAD-57 pulse CO-oximeter compared with standard laboratory carboxyhemoglobin measurement.
Click to expand...

Interesting.

The simple truth is, that despite the fact I'm a geek, and I love electronics and computers, when it comes to delivering pt care, the only one of my toys I actually trust is my EKG, because it's the only one where I can actually see the SNR and adapt the results accordingly.

I mainly use my pulse ox to have a number to put down, but I look for my pt presentation to actually determine their oxygenation status, though I will admit that SpO2 can be useful for trending data, provided that I'm doing it on something that let's me actually see the waveform (Read: My lifepak).

Automated NiBP is something I only use when again, I just want a number to put down, but I doubt seriously that the number is going to be clinically significant, if the machine gives me a number that's surprising, then I'll recheck manually.

The way I figure it, inherent to the nature of our job is that we're taking these measurements in an uncontrolled environment, which means that the quality of the data is suspect (Someone else mentioned using a hood over the probe to cut down on the signal noise), and that's only amplified by the fact that the basic methodology appears to be suspect with non-invasive CO-oximetery (Per the doc's link), quite beyond that, even assuming a good SNR and methodology, I'm not 100% comfortable trusting a machine to do interpretation, I don't know what it's algorithm is, and I don't know how many 9s it's designed to operate at.
 
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