pulse ox and fx's

[brentoli]

The pulse ox is good to confim what I feel for a pulse, on those hard to palpate pulses.

I write that little precentage down on the PCR.

Honestly though, I don't give alot of consideration to the precentage. If the paitent is breathing, and not blue, we are doing our job for the time.

[VentMedic]

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?

Good one!

The beeping bar graphs on many portable pulse oximetries may be misleading especially in a moving ambulance. In the hospital we will on rare occasions monitor the pleth on a monitor based pulse ox if we have a good base line established. Of course, we also have dopplers and a variety of other technology along with the old fashioned assessment of putting an X on the pulse point and occasionally checking it by using our fingers. If there is a good pleth with the palpable pulse , SpO2 should not differ from other areas. Of course, all the things Lilacmedic mentioned will affect reliability of the numbers. The SaO2 should be the same thoughout.

For accuracy to check pulse rate with the HR rate number on the pulse ox, we were taught to listen at the PMI of the heart's apex and palpate the arterial pulse. At the same time, this is also good for determining the heart sounds as an assessment point if you're involved in CCTs.

Depending on the age and/or condition of the patient, some adults haven't had good palpable pulses in the extemities in years even on a good day.

Usually if you don't have a palpatable pulse, the pulse ox is useless anyway. If you have a palpatable pulse, good. But I probably wouldn't want to leave a pulse ox attached for any length of time on an effected extremity for the possibility of poor circulation to some of the tissues. Pressure sores can easily form leading the way for other issues such a infection. That is the reason we don't normally monitor the SpO2 on an injured extremity in the ICU. If we must use damaged extremities, we will initiate more frequent site rotations. Or, even in the ICU, the pulse ox will be determined as useless for that patient and we'll just rely on other aspects of physical assessment such as color, RR, HR, BP, mental status and aggitation.

So, in answer to the initial question: No, I don't make it a practice of putting a pulse ox on an affected extremity for monitoring for any length of time if I can avoid it.

[mediccjh]

If he has an extremity fracture, why the f#@! does he need the pulse ox?

That is why I tend to break BLS pulse oximeters.

[scottymedic]

Following the methodology of CWMPS *Colour, Warmth, Movement, Pulses and Sensation* can assist in assessing blood flow to the affected limb. Pulse oxy could be a good idea in the assessment of saturation, but then as other posters as have pointed out, they are affected by temperature. And ccjh, there is no harm putting a pulse oxy on, this isnt bls vs als at all, bls put pulse oxy on here, just another good vital sign to write down and compare to manual observation skills. Just like you can write on a form that they had a pulse rate of 100 but the monitor can assist that it is a sinus tachy or ventricular etc. The tool just merely helps clarify the manual finding.

So original question, as medicrn said, why not try it out, and see what you can find, many great protocols were made through trial and error, I know I will try it and see what I find.

Scotty

[VentMedic]

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

The original post was for long term monitoring. I would take that for more then just a "sat check". Since donedeal also listed his occupation as ER tech, the pt could be in the ER for more than 4 hours easily which may be long enough to cause problems depending on the degree of injury. With swelling and then later casting or OR, any potential for sores and infection should be avoided if possible if it is not necessary especially those induced by the care givers. Granted if it is a 20 - 30 y/o with good skin intergrity and no hx of diabetes, monitoring on the affected extremity may not be a problem. However, for the very young and the very old, it can become a problem quickly which is why we have this long assessment form about every inch of skin on a patient if they are admitted to the hospital. I've also seen disposable probes taped in place not attached to a monitor and then missed for many hours as the patient goes through the system. The same standards for skin integrity care holds true for ER techs, RNs and RTs. ALS or BLS shouldn't be an issue for that. For perfusion checks, I don't believe a pulse ox is listed as a valid assessment tool because it will not tell you about skin color, warmth, sensation, swelling or quality of the pulse. A good pleth may be helpful, but too many other factors may skew accuracy for documentation of perfusion. In other words, this should not replace frequent checks by actually being at the patient's side.

Although, I did mention we have used its pleth in the ICU with a nurse and/or physician at the bedside but only only secondary to all of the other technology and manual skills.

[whit72]

mediccgh wrote:

If he has an extremity fracture, why the f#@! does he need the pulse ox?

Amen.

Because a fragment of bone could have broken off and traveled to his lung. Because they have nothing better to do on the way in. What els do you do with two hour transport times.

[ccmedoc]

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

no.

[donedeal]

no.

no meaning neither? when a high index or trauma alert comes into the hospital it is a requirement. Trauma alerts require continuous pulse ox monitoring. so in that case, which extremity?

[brentoli]

Why do they require it. Do you know the reason behind it?

[donedeal]

Based on the signifant injuries required to meet trauma alert criteria, which could include resp compromise and decreased perfusion. To monitor the patient for impending resp/cardiac failure.