View Full Version : Pulse Oximeters
Do you guys have any preferred brand of pulse oximeters which you'd recommend for field use?
Nonin, the finger tip model (onyx maybe). I have two, they are cheaper, lighter, and more efficient than the larger models.
Agreed, I loved our Nonin Onyx until we lost it.
[QUOTE=MIKE G;593027]Nonin, the finger tip model (onyx maybe). I have two, they are cheaper, lighter, and more efficient than the larger models.[/QUOTE
First time on your website; Great prices for invaluable equipment! Look for an order and referrals soon.
Drsal,
Thanks for the feedback, look forward to it.
Cslone,
They are definitely likely to walk off due to size. I trimmed the lanyard that comes with them so that I can cinch it down on the patients wrist or larks foot it into my bag.
I also mark mine obviously and in a secret spot should I need to recover one that "walks" off.
Thanks all. Looks identical to the one from training. Couldn't remember what it was called though.
Smith Medical Int. Model 0473 $100.
So small and light you will not beleive. Comes with a lanyard.
Gutshot John
03-08-10, 18:45
Nonin Onyx. My Dad used one for years small and efficient.
lethal dose
03-08-10, 19:10
Nellcor puritan Bennett.
on a side note....
what's the point of a pulse ox....in the field?
lethal dose
03-08-10, 19:24
on a side note....
what's the point of a pulse ox....in the field?
Where do you want me to start?
Where do you want me to start?
from the top?
from the top?
just for reference...
I'm a anesthesiologist with fellowship training in critical care medicine....and have spent time overseas in our second Gulf war.
...so ...kind of ...been there...done that...when it comes to taking care of really sick/traumatized people.
lethal dose
03-08-10, 19:36
just for reference...
I'm a anesthesiologist with fellowship training in critical care medicine....and have spent time overseas in our second Gulf war.
...so ...kind of ...been there...done that...when it comes to taking care of really sick/traumatized people.
What if someone has copd? Wouldn't wanna just slap a nonrebreather on 'em and blast 15l down their throat.
We utilize pulse oximetry much less than we used to. Capnography is indespensible in todays world however.
bingo.
NinjaMedic
03-08-10, 19:38
We utilize pulse oximetry much less than we used to. Capnography is indespensible in todays world however.
What if someone has copd? Wouldn't wanna just slap a nonrebreather on 'em and blast 15l down their throat.
look at the last American Thoracic Society's practice guidelines for management and treatment of COPD....I think it was published in the late 90's the last time I looked...
the hypoxic drive to breath has been debunked for over a decade.
so 15 l/m is GOOD.
you WANT to slap as much O2 as possible....
lethal dose
03-08-10, 19:42
look at the last American Thoracic Society's practice guidelines for management and treatment of COPD....I think it was published in the late 90's the last time I looked...
the hypoxic drive to breath has been debunked for over a decade.
so 15 l/m is GOOD.
you WANT to slap as much O2 as possible....
Only as much as they can tolerate, though... no? Too much and they can de-sat.
Only as much as they can tolerate, though... no? Too much and they can de-sat.
No....I don't think so....
according to the statement from ATS...and from my own clinical experience.
High O2 concentration may increase dead space, but won't cause problems with oxygenation in patients with COPD exacerbations........
yes, their pCO2 may rise, but that's not the problem...the problem is hypoxia.
So ...bottom line....give oxygen....make sure air is going into and out of the lungs......etco2
lethal dose
03-08-10, 20:14
I've always been told that too much o2 on a copd'Er knocks out their hypoxic drive... thus resulting in an affected spo2 level... no? I'm curious, but that's how we practice.
I've always been told that too much o2 on a copd'Er knocks out their hypoxic drive... thus resulting in an affected spo2 level... no? I'm curious, but that's how we practice.
Another one of those theory based ideas burnt into everyones brains without any scientific proof.
Is it possible, yes. Is it likely, nope.
From Harrisons:
OXYGEN Supplemental O2 should be supplied to keep arterial saturations
90%. Hypoxic respiratory drive plays a small role in patients
with COPD. Studies have demonstrated that in patients with both acute
and chronic hypercarbia, the administration of supplemental O2 does
not reduce minute ventilation. It does, in some patients, result in modest
increases in arterial PCO , chiefly by altering ventilation-perfusion 2
relationships within the lung. This should not deter practitioners from
providing the oxygen needed to correct hypoxemia.
UpToDate also has a good article on this topic: Use of oxygen in patients with hypercapnia They cited a few studies, one of which was where ARF pts were given 5L O2 and even though there was a slight decrease in minute ventilation that it couldn't account for the total increase in PaCO2, and even though ventilatory drive decreased it was still higher than in controls implying it was still being augmented by other factors.
Pulled the physio text back out, O2 really has no direct effect on central ventilatory regulation, basically only on peripheral chemoreceptors.
lethal dose
03-08-10, 22:37
Very interesting. I'm gonna have to keep reading, fellas. This has really got me wondering.
+1 to the COPD debunking. Conversion to hypoxic drive is not as common as most once thought and even then giving them O2 in the short term is not going to be a major concern in reality.
As to use in the field, I do not use it as a snapshot but as a trend just as all other vitals should be used. I can stick the pulse ox on a patient and confirm that a palpable pulse matches the pulse ox reading then I have pretty good confidence that I can trust at least the pulse reading. This can be helpful when treating multiple patients as I just have to glance and I can get a pulse. As for the SaO2 reading I watch it as a trend and consideration and not a compass. If it is high when I first put it on and perform a treatment and it goes down I am going to have one more piece of information when reevaluating my treatment same in reverse if it is low when I stick it on and I perform my assessment and treatment and it improves then I have one more bit of feedback on my patient. Remember, treat the patient and not the monitor. Capnography, particularly waveform is very useful but is not inexpensive or super portable which makes it difficult for fielding in wide use.
I would love to have a PDA sized device that could give me 12 lead, SaO2, ETCO2, ABGs, and half a dozen other things that was visible under night vision, did 10 second processing, trending, cost under $1k, was water and shockproof, and I got a free sample ;-) but that aint happenin. I will take every little bit of information I can on my patients but understand that I will not be blinded by a single piece of information. If my patient looks like shit and the SaO2 is 100% I am not going to pat them on the shoulder and finish my paperwork.
Just my thoughts,
lethal dose
03-08-10, 23:06
Well put, mike. I'm gonna have to read up. I work at a small community hospital... maybe we're still in the old skool. Thanks for the insight, gentlemen.
Yeah..... er....... what Mike said.
+1 to the COPD debunking. Conversion to hypoxic drive is not as common as most once thought and even then giving them O2 in the short term is not going to be a major concern in reality.
As to use in the field, I do not use it as a snapshot but as a trend just as all other vitals should be used. I can stick the pulse ox on a patient and confirm that a palpable pulse matches the pulse ox reading then I have pretty good confidence that I can trust at least the pulse reading. This can be helpful when treating multiple patients as I just have to glance and I can get a pulse. As for the SaO2 reading I watch it as a trend and consideration and not a compass. If it is high when I first put it on and perform a treatment and it goes down I am going to have one more piece of information when reevaluating my treatment same in reverse if it is low when I stick it on and I perform my assessment and treatment and it improves then I have one more bit of feedback on my patient. Remember, treat the patient and not the monitor. Capnography, particularly waveform is very useful but is not inexpensive or super portable which makes it difficult for fielding in wide use.
I would love to have a PDA sized device that could give me 12 lead, SaO2, ETCO2, ABGs, and half a dozen other things that was visible under night vision, did 10 second processing, trending, cost under $1k, was water and shockproof, and I got a free sample ;-) but that aint happenin. I will take every little bit of information I can on my patients but understand that I will not be blinded by a single piece of information. If my patient looks like shit and the SaO2 is 100% I am not going to pat them on the shoulder and finish my paperwork.
Just my thoughts,
perhaps the pulse is helpful....but as for the SAO2 number in the field....I don't know....
CO exposure....hypotension...dirt...etc....always make the number suspect..at least to me..
if it's low, and you're giving a face mask by NRB....what else is there to do...
if it's a 100...and the guy looks like doo doo...are you not going to intubate....?
I just think that field care..(along with in house care) has become too technology dependent.
Iraq Ninja
03-09-10, 05:38
Our PO has been missing from our med bag for a few months, and I will have to buy one on my own to get another one (original was a gift from an other unit), so this discussion has been interesting.
Honestly, I have been avoiding the issue but Mike G makes some good points.
perhaps the pulse is helpful....but as for the SAO2 number in the field....I don't know....
CO exposure....hypotension...dirt...etc....always make the number suspect..at least to me..
if it's low, and you're giving a face mask by NRB....what else is there to do...
if it's a 100...and the guy looks like doo doo...are you not going to intubate....?
I just think that field care..(along with in house care) has become too technology dependent.
I hear ya on the tech dependency, my response isnt to throw out the tools we have but to educate providers to not be dependent or use them as compasses. Part of that is understanding the limitations you mentioned as well as learning effective assessment techniques without the technology.
I do remember an AAR at SOMA a few years ago from a SOF provider. Said he had a situation with multiple patients with respiratory issues after some sort of engagement. He had multiple Onyx pulse ox units and use them on his patients. He was limited as to the amount of O2 he had and used the feed back from the pulse ox to titrate the O2 to where the patient's SaO2 was in a comfortable range for him but also to where it would last for the expected flight. He reported that if he dropped below a certain threshold of Lpm that the SaO2 dropped significantly so he found a balancing point. Who remembers how to do O2 calcs?
Not my case but something to think about.
I like having a pulse ox available for info at a glance. I use a little fingertip one, manuf escapes me. I'll look next time I'm in the bag. I'm fine without one, too. As teachers and mentors have beaten into my head, "treat the patient, not the numbers."
I hear ya on the tech dependency, my response isnt to throw out the tools we have but to educate providers to not be dependent or use them as compasses. Part of that is understanding the limitations you mentioned as well as learning effective assessment techniques without the technology.
I do remember an AAR at SOMA a few years ago from a SOF provider. Said he had a situation with multiple patients with respiratory issues after some sort of engagement. He had multiple Onyx pulse ox units and use them on his patients. He was limited as to the amount of O2 he had and used the feed back from the pulse ox to titrate the O2 to where the patient's SaO2 was in a comfortable range for him but also to where it would last for the expected flight. He reported that if he dropped below a certain threshold of Lpm that the SaO2 dropped significantly so he found a balancing point. Who remembers how to do O2 calcs?
Not my case but something to think about.
Completely forgot about that issue, and an excellent point...when I was in Gitmo, we used to run OUT of O2 at the hospital when the H cylinders would run dry.
I guess I'm thinking in terms of being in the "field" as a civilian.
I guess with only 600 liters in a E-cylinder...you really can't waste it like you do in the hospital.
NinjaMedic
03-09-10, 18:05
I guess I am getting cynical now days but in my opinion it is fairly difficult to kill someone in the pre-hospital environment (with the exception of inappropriate paralysis) and just as difficult to truly save someone. Most everything we do (in a non-extended care situation) to save people can be done by an EMT-B, beyond that its all comfort and feel good measures. Of course everything has at least a perceived medical benefit or we wouldn't do it or use it.
Lets say the Hypoxic Drive is real and if you place a COPD pt on oxygen they completely stop breathing. Now what do you do? Lets start by taking them off high-concentration oxygen. If they still look crappy and you think their pulmonary or respiratory status is causing it . . . ventilate them! Realistically a COPD pt can survive at 80 or 85% for a while and how many COPD patients will you be caring for in an unsecured tactical environment?
Now I am not knocking pulse oximetry or saying it is outdated or useless, it certainly has its place but I dont think that place is as a first line assessment tool in civilian tactical situations.
My wife just got a new one yesterday from Devon Medical. Is cost $65.00. I went to the store. When I cam back I found out she left it on the bumper of my truck and had run over it earlier.
What if someone has copd? Wouldn't wanna just slap a nonrebreather on 'em and blast 15l down their throat.
Well, if they are dyspneic than I would. You are not going to send a COPD Pt into respiratory failure unless you are blasting them with high concentrations of O2 for hours. It goes back to the old adage, "Treat the patient and not the machine!"
Also, for the point of knocking out a COPDers Hypoxic Drive, Ventilate them and titrate the O2 back down to a level that pleases their barroreceptors!
FWIW, I worked out in the field before pre-hospital pulse oximeters were prevalent as they are now. It really is not a difficult situation unless you want to make it difficult, if they are dyspneic, give them O2. If their hypoxic drive become satisfied and they quit breathing, bag em!
on a side note....
what's the point of a pulse ox....in the field?
I agree that its a " nice to have" not "need to have" tool, the greatest majority of the time. To be complete though...
If your field is high altitude, it's useful. as a baseline, and to trend. To track people that are on the bubble as far as acclimating, to convince others its time to go down. It's also fun to play stupid games and see how low you can get the number to go by running around camp, and holding your breath. My personal best is around 60% at 20,000 ft, at least thats what i think i remember, it's all rather fuzzy.
Since not everybody has a gamow bag, o2 cylinders are heavy, and a whole bunch of logistics goes into moving the non-ambulatory over technical terrain, having that pulse ox guide some of your decision making in regards to descent : how far/when/ how urgently/have we gone far enough/are we going down fast enough/can we stop here for awhile issues.
I've done without the pulse ox in evac'ing people from up high, but even as gram conscious as I am in that setting, the nonin fingertip models are nice to have.
If for no other reason than it gives you a number to look at in the tent, at night, instead of.: " I dunno, do his lips look a bit more blue to you?" " No dumbass you have your blue LED lamp on". "oh, yeah, uhh dude, would you say that you are feeling more, or less shitty than you were an hour ago?"
As far as the COPD nonsense.. if the pt appears to be having difficulty breathing, give them O2... if you can't figure out that they are about to tucker out and stop breathing just from the abundantly clear clinical signs they are showing you...that pulse ox isn't gonna help. If they stop breathing due to their high co2 levels, than you get to bag them. at 100% FiO2. Let the RRT's worry about the weaning protocol....a few hours / days / weeks from now.
Drsal,
Thanks for the feedback, look forward to it.
Cslone,
They are definitely likely to walk off due to size. I trimmed the lanyard that comes with them so that I can cinch it down on the patients wrist or larks foot it into my bag.
I also mark mine obviously and in a secret spot should I need to recover one that "walks" off.
Only ever used the nonin's but they work fine..
Yeah they tend to grow legs and walk away; I've acquired several this way, anyone know who's this is? going once, twice, mine.... I use a paint marker on mine for easy ID, also wear it on a scissor leash, I try not to keep mine on a PT...
On ICU rotation this month and a few of the pulm/critical care docs carry one around with them. Seems like they've run into more than their fair share of bad/defective hospital disposable pulse ox sensor leads and will usually throw their unit on real quick to verify if there's any question.
citizensoldier16
04-29-10, 19:37
I have a Nonin fingertip model that's held up well. Working in EMS though (paramedic) I rely less on Sp02 and will almost always reach for the capnometry/capnography in assessment and diagnosis of respiratory patients. In fact, the pulse ox is just about the last diagnosis tool I attach to any patient Just my $0.02.
I've only recently graduated paramedic school and just have about two years of EMS experience, but a couple of questions came to mind when reading the discussion of the hypoxic drive and the potential for knocking it out.
If you were to give too much O2 and cause the patient to stop breathing due to them no longer being hypoxic, would they start breathing again once they again became hypoxic if you weren't bagging them?
If it is possible to stop someone's breathing due to O2 overdose, wouldn't they likely be better off in the short term if you were to bag them with a high concentration of O2? Being in a state of constant hypoxia isn't exactly healthy after all.
citizensoldier16
05-10-10, 06:26
There are numerous and inconsistent opinions on hypoxic drive. As an EMS provider, you should never withhold oxygen from ANY patient experiencing respiratory compromise. From all the literature I've read (NEJM, JEMS, Paramedicine Today, Mosby, Brady, etc) the effects of high-flow oxygen on the hypoxic drive takes days to months to manifest in patients, and symptoms take even longer to show up. You may have heard that you shouldn't give a COPD patient oxygen, but I'll tell you what my paramedic instructor once told me:
"Nobody has ever died from too much oxygen, but plenty of people HAVE died from a lack of it."
If your patient is in respiratory distress, the first intervention should always be high flow oxygen. Nine times out of ten, that'll fix their problem. If not, then something (fluid) is preventing gas exchange in the lungs and then we can then start looking at options like Lasix, CPAP/BiPAP, or even Nitro.
EDIT: Just remember that a patient exposed to carbon monoxide will have a very high SpO2 reading because hemoglobin would rather bind with CO than with O2. Keep that in mind, and don't rely fully on your pulse-ox. As I said before, I would rather reach for the capnometry first.
Also, for the point of knocking out a COPDers Hypoxic Drive, Ventilate them and titrate the O2 back down to a level that pleases their barroreceptors!
I believe you meant chemoreceptors, and there are newer pulse oximeters available which measure carboxyhemoglobin, and methemoglobin as well. I believe these would be far more useful (in the field) than simply measuring O2 saturation. We monitor Spo2 routinely, but place much greater emphasis on ETCO2 as a measure of adequate/inadequate ventilation. I think there'll always be a place for pulse oximetry, unless you choose not to utilize it and instead use an ISTAT, or similar device for gases. That's expensive though on an ongoing basis. Just my 0.02.
There are numerous and inconsistent opinions on hypoxic drive. As an EMS provider, you should never withhold oxygen from ANY patient experiencing respiratory compromise. From all the literature I've read (NEJM, JEMS, Paramedicine Today, Mosby, Brady, etc) the effects of high-flow oxygen on the hypoxic drive takes days to months to manifest in patients, and symptoms take even longer to show up. You may have heard that you shouldn't give a COPD patient oxygen, but I'll tell you what my paramedic instructor once told me:
"Nobody has ever died from too much oxygen, but plenty of people HAVE died from a lack of it."
If your patient is in respiratory distress, the first intervention should always be high flow oxygen. Nine times out of ten, that'll fix their problem. If not, then something (fluid) is preventing gas exchange in the lungs and then we can then start looking at options like Lasix, CPAP/BiPAP, or even Nitro.
EDIT: Just remember that a patient exposed to carbon monoxide will have a very high SpO2 reading because hemoglobin would rather bind with CO than with O2. Keep that in mind, and don't rely fully on your pulse-ox. As I said before, I would rather reach for the capnometry first.
Except in cases of severe Paraquat poisoning; O2 should not be administered unless signs of severe respiratory distress are present. It causes severe lesions in the lungs when given to victims of Paraquat poisoning. Everything else in this post is dead on accurate.
I have been a NREMT-P for 18 years and have been teaching Paramedic courses for the last 5 years; my students have a better that 90% first time pass rate on the national registry exam.
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