pulse ox and fx's

[donedeal]

Do you put pulse ox on the extremity with a poss fx or on the unaffected extremity for long term monitoring?

[MedicRN]

Do you put pulse ox on the extremity with a poss fx or on the unaffected extremity for long term monitoring?

Before we go telling you the answer, why don't you tell us what you think the answer is and why.

[whit72]

Do you understand O2 saturation? How it works?

[donedeal]

pulse oximetry measures the percentage of saturated hemoglobin through 2 different light sources which are capable of calculating bound and unbound molecules of hemoglobin and presenting that difference in a percentage form. So my educated guess would be to put the pulse ox on the fx site to determine peripheral perfusion. If you receive a percentage less than expected based on pt respiratory status then you can further determine that the effected extremity is not being perfused (combine pulse oximetry with CSM) because of a potential fx. By putting it only on the unaffected site you neglect the additional opportunity to determine perfusion to the fx extremity. So my answer would be to check the fx site first. If you get a normal percentage as based on pt's resp condition, then leave it. If you get an unexpected percentage then try the other hand. But always remember to treat the pt, not the technology.

[JPINFV]

Slight problem there sparky (I'm gonna start using terms like sparky, sport, etc when people bring out the tired old cliches like "BLS before ALS," "treat the patient, not the monitor," "you lose 1 BLS skill for every ALS skill you learn [wow, doctors must be screwed by this one]," etc).

Why would the hemoglobin be any less saturated? Sure, you might have less RBCs passing the Fx due to decreased perfusion (along with things like changes in color, decreased sensation, decreased pulse, increased cap refill time), but that wouldn't change the percent of HGB bound with oxygen.

2. Cliche time: Sure, you don't just act like a monkey and go, "OMG the pulse ox is reading 50, TRANSPORT CODE 3, TRANSPORT CODE 3!" You use it as tool to help determine the patient's status, the needed interventions, and how well those interventions are working. I guess, after all, if a 12 lead is indicating an acute MI (human interpretation, not the machine's), but the patient doesn't have chest pain, then there isn't an MI? After all, we should fear machines more than inadequate providers that gives rise to such cliches.

2.a. That said, basics do save paramedics.

[spoil:46d2e19d7b]from doing manual labor[/spoil:46d2e19d7b]

[medic001918]

Slight problem there sparky (I'm gonna start using terms like sparky, sport, etc when people bring out the tired old cliches like "BLS before ALS," "treat the patient, not the monitor," "you lose 1 BLS skill for every ALS skill you learn [wow, doctors must be screwed by this one]," etc).

I like this rule. It applies and it made me laugh.

Otherwise, good description of pulse oximetry and why it's not the best tool for all providers to use. There have been multiple threds on pulse oximetry and the ALS and BLS provider. They've all followed the same road. Feel free to use the search function to find them and review.

Shane

NREMT-P

[Dustdevil]

Meh... it's a fair and relevant question. I can't say I've ever seen this specifically addressed here.

On the other hand, I do like MedicRN's approach. Think it through for yourself. Formulate an opinion. Then toss it out for discussion.

Test yourself!

[mrmeaner]

I don't think I would wait for the pulse ox to tell me there's poor perfusion in the extremity. Kind of like using the smoke detector for an oven timer, no?

[Lilacmedic]

Pulse oximetry....ah, the myriad of false negatives and false positives that little gadget can throw at us!

Nice little toy but what stands out for me is that the pre-calibrated graphs are based on tests done on NAVY SEALS. Just a pity most of my patients don't fall into that category. (and location where SEALS are found aren't the only factor! lol)

Plus our cousin mr. Hb affinity to O2 is pretty sensitive when it comes to temperature, 2,3-DPG, PCO2, change in pH. And then all the little external factors like nail polish, correct fittment of probe etc.

[pacman]

Oh the good old pulse ox.

I was on one of my first calls for a seizure patient. I did all the vitals and didn't think much of it because there was nothing that was out of the ordinary. However, I decided to attach the nice little gadget and immediately went to my partner ( who was driving ) " Hey hurry up! His pulse ox is telling me he has a 82% oxygen saturation!" I was freaking out!

My partner laughed and I couldn't understand why. She told me to look again and the oxygen saturation was at a good 98% while I'm there doing the tango with a nonrebreather. After the call she tells me that I should have waited for it to get a "finalized" reading.

Since then I realized that the pulse ox is only good to confirm what I should be doing anyway, which is to give high flow oxygen. Besides securing an airway and assisting ventiliation with an ambu-bag when needed, there isn't much more I can do as an EMT-B with a pulse ox reading.