Masimo RAD 57 SPCO oximeter? Anybody use?

[jafo]

Apologies if this has already been discussed, I searched and found no reference...

We are a rural department, and during the fall and winter we get a lot of Carbon Monoxide calls, both for Fire and EMS. Most are bad batteries in the household detector system, but a few times a year it is a valid call with symptomtic patients. Knowing the extent of the CO saturation is, of course, impossible to determine in the field so treatment is always high flow O2 and fight with them to go to the hospital ("I feel much better now..").

I recently saw the new RAD 57 unit that masimo came out with a year or so ago which gives CO sats in the same way as a pulse ox, it also does the usual O2 level, pulse rate, and a couple of other levels depending on the model you get. This is a legitimate device and the only one on the market that has an FDA rating as 'proven effective'. They are marketing it to hospitals, EMS, and Fire departments (for rehab, there are some interesting studies there, but that's another thread).

My question is does anyone out there have one of these units and can you share some experiences with us of how it works. I'm also interested in how you would be recieved at a hospital when you inform the staff that the patient has a SPCO of 18%? We have a hospital here that blows off most of what we tell them, I can only imagine what they would say if we provided SPCO when it was pertinent.

The unit sells for $4,000, but I am considering working on a grant to get one in our department for patient care and firefighter rehab. We are rural and work closely with neighboring departments, so we'd probably provide it's use on structure fires to other departments if they wanted it.

Looking for input,

JAFO

[Redcell19512]

We bought one last year. The ER where we take 80% of our patient's has two of them so the results are well recieved when we bring pt's in with SPCO readings. The cost was steep so we only bought one which we run on the supervisor's ALS response vehicle. Hence, we don't have a lot of experience with it.

On a side note, once we bought the RAD57 we found out from our medical director that in PA, technically finger probe measurement of SPCO is outside of our scope of practice. That's according to the State Medical Director (no I can't remember his name). The state is supposedly visiting the issue which is a good thing when you consider they have the RAD57 on the approved item list for EMSOF funding :roll:

I've personally used it twice. Once on a change in mental status call where a kerosene space heater was in use. Second time was one of those 2 am CO detector activations. Family of 5. I was able to check all 5 patient's with the RAD 57, all were below 3%. Fire dept got zero ppm readings throughout the house. Seemed to set the parents minds at ease that I had a machine that could tell them everything was "ok".

Down side is of course training. We didn't have any.

[Spock]

The RAD-57 is indeed outside the scope of practice for PA medics. Not sure why but then there are many things PA does that make no sense. We are going to get 5 units as part of a research project once 90% of our staff completes the training. We are going to use it on all patients in order to develop a data base. There are several services participating in the study.

Normal values are important. Non-smokers should have readings <5% while smokers should be <10%. The device has a plus/minus factor of 3%. I have read anecdotal reports which question the accuracy of the RAD-57 and when we had it in for training all of the smokers had readings <5%. When we get the units I fully intend to get a base line reading on myself and then light up a big cigar to see if the number goes up!

Don't forget that correlating the CO level in the field with carboxyhemoglobin levels in the hospital are greatly affected by the transport time with the patient on high flow oxygen. If transport takes a few minutes there may not be much of a difference. If transport is much longer the difference would be significant because oxygen is the treatment for CO.

Good luck. If you can get grant funding for the unit it might make sense as long as your service does not have greater needs. As always, treat the patient and not the monitor.

Live long and prosper.

Spock

[p3medic]

Its a nice piece of equipment, we carry them on our ALS trucks and supervisors vehicles, bright light, like flashing strobes or even bright sunlight can throw them off however.....

[Medic2588]

As an Advanced Hazmat Life Support instructor and Hazmat Tech, I'm curious to see why this piece of equipment would be of any value to anyone in the prehospital setting. If you suspect the person has inhaled Carbon Monoxide, the only course of treatment you have is Oxygen. I'm not sure what other decisions you would need to make for a CO poisoning. As a myriad of factors can influence the way a Pulse Ox reads, I'm sure the SpCO detector can be equally influenced. Therefore, the only way to truly know how much CO a person has been exposed to would be to draw blood and measure the carboxyhemoglobin levels.

Devin

[p3medic]

Its a good tool for triage decisions when multiple pts need tx....some pts will benefit from hyperbaric o2 therapy, and having a co level in the field helps with those decisions....obviously all symptomatic pts will be tx with o2, but some may need more...

[Medic2588]

I'm still not convinced. More than just a carboxyhemoglobin level is needed to determine hyperbaric oxygen, and triage for multiple patients should be standard regardless of the cause of the MCI. A standardized system like START or SMART should be used and hyperbaric therapy decided upon by the emergency room after the blood levels are checked.

Devin

[p3medic]

One of our MD assoc med directors, who is also a toxicologist would beg to differ....different strokes for different folks I guess....I don't know about were you are, but here there is 1 hospital with a hyperbaric chamber, so if i'm sending a dozen pts to the hospital, it would make sense to send those with the highest co levels and sx's, or special populations such as pregnant women and children, or those with cad to the appropriate facility. Its certainly not the be all end all of co detection, but its non invasive, pretty acurate from what we have seen and is a good tool to have, IMHO

[Medic2588]

Here we have one in the region capable of using hyperbaric oxygen for treating CO poisonings (not all chambers are created equally). So we transport all patients to local hospitals and then ship them out if they need hyperbaric O2. CO poisonings rarely produce large amounts of patients requiring hyperbaric therapy.

But I guess it all comes down to local protocols.

Devin

[jafo]

Thanks for all the feedback. It's helpful to know that these are being used in the field and working as an additional tool in patient care, as well as showing some usefulness.

I think some may have misunderstood the purpose by jumping right to a decision about the type of treatment a particular patient may require.

The reason we are looking into this purchase and addition to our tool kit is for prehospital evaluation. It's easier to get a relutant patinet to go to the hospital for evaluation if you can tell them "we have an indication that your carbon monoxide levels are a little too high and think you should be evaluated in a hospital". Than to just say "well, it's possible...". Also I'm more concerned about the firefighters we rehab at structure fires. I would like to know if he/she looks wiped out and winded because he/she overdid it, or because he took his mask off while doing overhaul and got a snoot full of CO.

Thrid reason is, there is a ton of clinical documentation of patients going to a hospital with symptoms that get diagnosed as the flu and sent home. Hospitals only check for possibilitis that are indicated. A person with the flu can present the same as a person with a bad heater vent at home. The hospital has no way of knowing to 'look there'.

We're not trying to provide diagnosis and treatment regimens, we are trying to provide the receiving facility with the best possible set of information possible on each patient.

Thanks again,

JAFO