Pulse Oximeters

[ST911]

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."

[gan1hck]

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]

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.

[HES]

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.

[lwhazmat5]

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!"

[lwhazmat5]

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!

[lwhazmat5]

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!

[Solo1st]

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.

[Doc_G]

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...

[FL2011]

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.