When to believe the pulse oxymeter, when not?

[thrutheashes]

Hope I'm never in your remote area when I'm in a perfusing v-tach, or silent MI, or,or,or.......

Hey, contrary to what the lifepack says, if I'm chatting with someone, and I can palpate a pulse, I'm going to have a hard time believing the patient is in asystole if it's showing on the monitor. Just saying.

Our tools are nice, they help us do our job, however it is possible to be too reliant on them. That's all I'm saying. The tools are half of it. The practioner's experience and intuition are the other half. such as the case in the op's original post. Does this SPO2 reading make sense? Does BGL reading make sense with patient presentation? Or what if your equipment dies and you have to assess the old fashioned hands on way, using auscultation, palpation, and vision? I've seen newer EMS practioner's who, quite frankly, don't have the problem solving abilities to assess without those toys.

The toys are nice, but not without the basic understanding behind them.

[BEorP]

Our tools are nice, they help us do our job, however it is possible to be too reliant on them. That's all I'm saying. The tools are half of it. The practioner's experience and intuition are the other half. such as the case in the op's original post. Does this SPO2 reading make sense?

Okay, so let's say you have a patient who has a low SpO2 with a good waveform. If this "doesn't make sense" with your general impression of the patient, what are you going to do?

[thrutheashes]

My treatment would vary based on pt. particulars, but as presented I'd go low flow o2 and see if the sat were to go up. That said, as long as color,resps, v/s are stable I would not go any more aggressive than low flow. Conversely, I have someone who has sats reading high, yet they are struggling for breath, showing cyanosis, I am going to treat more aggresively. I'm not trying to say that the tools are irrelevant. I will always side with pt. safety. But sometimes you have to rely on what you see, not what the gizmo's tell you.

[mobey]

My treatment would vary based on pt. particulars, but as presented I'd go low flow o2 and see if the sat were to go up. That said, as long as color,resps, v/s are stable I would not go any more aggressive than low flow. Conversely, I have someone who has sats reading high, yet they are struggling for breath, showing cyanosis, I am going to treat more aggresively. I'm not trying to say that the tools are irrelevant. I will always side with pt. safety. But sometimes you have to rely on what you see, not what the gizmo's tell you.

Would love for you to head over to my resp senario and apply your logic. I'll think you will find your assessment skills are only as good as your educational background and FUNCTIONAL experience. That is why we use machines.

[thrutheashes]

Would love for you to head over to my resp senario and apply your logic. I'll think you will find your assessment skills are only as good as your educational background and FUNCTIONAL experience. That is why we use machines.

fair enough!

[DwayneEMTP]

Would love for you to head over to my resp senario and apply your logic. I'll think you will find your assessment skills are only as good as your educational background and FUNCTIONAL experience. That is why we use machines.

If that is truly the case then you shouldn't have machines, nor an ambulance...

If you're 5 minutes from a hospital, then ok, as that's rarely real medicine, but further? If you feel that providers can't provide without machines, at least for a little bit, then man...I hope I hope I never fine myself obtunded in your area when your monitor and glucometer bite the dust...

Dwayne

[mobey]

If that is truly the case then you shouldn't have machines, nor an ambulance...

If you're 5 minutes from a hospital, then ok, as that's rarely real medicine, but further? If you feel that providers can't provide without machines, at least for a little bit, then man...I hope I hope I never fine myself obtunded in your area when your monitor and glucometer bite the dust...

Dwayne

Seems you may be a little obtunded now?

Jokes aside....

You may be misinterpreting the point I am making.

I am not saying providers cannot provide without machines, nor am I saying rely solely on your machines. I AM saying a diligent provider at any level will use machines to compliment thier assessment.

The mantra of "Treat the patient not the machine" is a great slogan for those who cannot interpret blood gases, or cardiac rhythms (When I do a rhythm class I hear it at least twice from the weaker students). But the reality is, that is not condusive with being a thorough practitioner.

I am sure that you have printed off a 12 lead at some point, or even hooked up the monitor and thought to yourself "Huh... wasn't expecting that" and changed your treatment plan somewhat based on your findings.

I know the guy with the radial pulse at 55bpm complaining of general fatigue could have just gotten a ride to the local hospital and tucked in for a nap. But when I hooked him up and saw the 3rd degree HB, he got a ride to the city for a pacemaker.

How about a greenstick or growthplate fracture in a pediatric found on x-ray, but no obvious swelling/deformity to the limb on visual inspection?

I am pretty sure we are the only ones who encourage eachother with these rediculous catch-all phrases, and to be honest... it is a little embarrasing.

[systemet]

Further to what mobey posted.

* Who thinks that they can diagnose an MI without an ECG?

* Who thinks that they can determine whether the previous patient should receive TNK / other thrombolytic de jour?

[flamingemt2011]

I would not feel comfortable administering TNK without a 12 lead, but yes I can diagnose an MI without an ECG.

To counter your argument, you have a 60 year old male with a hx of 2 MIs, complaining of crushing chest pain, 10 out of 10, with radiation to left arm, who is also hypertensive. Your monitor dies, are you going to withhold NTG and MS ?

[JPINFV]

Further to what mobey posted.

* Who thinks that they can diagnose an MI without an ECG?

::Raises hand::

Well, you never said anything about troponin levels.