Search the Community

Dwaynes post on another topic made me think again (thank you) about two recent calls, where we used four different pulse oxymeters. Call#1: >80 y/o male, felt to the floor, 4 x oriented, some bruises on the head, nothing else, pulse and BP pretty OK (don't remember, but nothing special). The initial SpO2 reading was 60%! However no indications for a real need of oxygene from general patient appearance. Totally awake, sat on the bench, normal breathing, no record of lung or breathing problems, no acute indications for additional O2 other than the pulse oxy reading. The pulse oxymeter was one of those finger clips, we use in our staff transporter (just happened to be nearby the scene as it was dispatched, so I did first responding). The finger clip fitted well, reading didn't change after resetting and re-applying, it had fresh batteries and usually gives good readings when tested. It is licensed for professional use as well. Despite this, according to the perfect patient state I gave no oxygene. The reading on the responding ambulances pulse oxymeter (other brand, hand held - no finger clip) was perfect in the 95% range, as expected. Call#2: On a patient ~70 y/o male suffering from "something with the heart" (totally unspecific) I attached the SpO2 sensor of our LP12, but couldn't get a decent signal. After fiddling some seconds, I re-attached to our hand held pulse ox (other brand) and it instantly got a signal of >90% and a pulse of 70/min. That seems very reasonable according to the patients general appearance. Then from the 3-lead ECG we got a first A-fib diagnosis, from the immedeate following 12-lead it was a clear additional left branch block. BTW, heart frequency was 140 and pressure 150/0 (zero!) - nice exact cook book view of a "half pulse" palpation and on the critical edge of a compensated heart failure (patient just walked up to the bath room in the first floor and sat there fully oriented). In this scenario I blame the LP12 pulse ox for not getting any signal (just some bleeps, but no measurement) where the other still was able to. On the same finger. Would like to have thought of additionally attach the other pulse ox on another finger, but that was not the time and patient to experiment. I since then feel I can't trust our pulse oxymeters any more...(they all are well known brands and licensed for professional use plus checked regularly according to manual). Sure I'm somewhat able by myself to see if a patient really needs oxygene and I always take general patient appearance in count (first half of my EMS life there was no such thing as a pulse ox!), but with todays doctrine to not force SpO2 over 95% - my own senses ability simply are not that exact on every %... So I have following questions: How do YOU really know to trust your SpO2 readings? Dwayne states in the mentioned posting, that "to many times people are/were suffering, and/or dying because providers didn't treat them because the pulse ox said that they didn't need to." How comes this? Beside true application errors (including deflective finger nails), the only real false-high reading of pulse ox I know is a CO poisoning. All other problems would give no reading (no signal) or false-low readings - how can this lead to provider's not giving oxygene? In my case#1 I decided so because of the general apperance (and was correct), a less imaginative provider may have given O2, because of low reading, but most probably this wouldn't have done any harm. Do we really need pulse oxymeters or the SpO2 value (if we can't trust it anyway)? Would like to hear your thoughts (I will share mine later), thanks! (P.S.: I will check all our four oxymeters on one test person soon, just getting curious)