Pulse Oximetry Assessment Tips (#31daysofCE)

by on December 20, 2009

in EMS Tips

You should be able to tell from the doorway if your patient needs oxygen. Simply gauge their rate and effort of breathing. I don’t think you need a “room air” pulse ox to confirm if the patient needs oxygen. If a patient really needs oxygen because they have:

  • tachypnea
  • bradypnea
  • pallor
  • cyanosis
  • intercostal muscle retractions
  • nasal flaring
  • accessory muscle use

Don’t delay oxygen administration to apply a pulse oximeter. At that point the reading, usually lower than even you might expect is merely interesting. And what are you going to do if the pulse ox says 94%? Not treat the respiratory distress. If you see respiratory distress treat it by correcting ventilation and/or perfusion problems.

EMS Service Manager Aaron Scharf, Manager of the EMS Department at Long Island College Hospital shared his thoughts about pulse oximetry with me:

“As far as pulse oximetry goes – and this is a pet peeve of mine with newly certified EMTs. They rely on the handheld device for evaluation of a patient’s pulse. The EMT will simply stick the probe on a patient’s finger, read off the numbers to their partner, and move along with the patient assessment. The things that are obviously missing from using this approach are the inability to determine quality and regularity of a pulse. The thing that’s less obvious, but I think more crucial is the fact that it eliminates physical contact with the patient which I think this is especially important for pediatric and geriatric patients.”

Aaron continues, “We are called to someone’s house, usually a stranger, and we establish an intimate relationship with them based upon the trust and presumed competence they infer from our uniform, level of certification, and our professional demeanor. But the further we remove ourselves from that patient by allowing equipment to intervene, the more we contribute to the dehumanization of medicine.”

Patient assessment is a hands-on process that also allows us to use our senses. Respiratory and pulse assessment should involved careful looking, listening, and feeling for more than just confirming the presence of breathing and the presence of a pulse.

When do you think is the best time to use a pulse oximeter?

To review the patient assessment process visit RapidCE.com for a two part lesson. Part 1 explores and reviews the scene size-up and initial assessment. Part 2 is an in-depth review of the secondary assessment, which is also known as the focused history and physical exam. Both lessons feature photos by paramedic and photographer Kyle David Bates.

For more on Pulse Oximetry read this recent article from EMS1.com by Kelly Grayson.

What are other limitations to pulse oximetry assessment?

  • http://www.genmedshow.com Scott

    Maybe I’m right, maybe I’m wrong…

    I use the pulse-ox (if it’s showing a good waveform) to confirm what I’m feeling on the opposite wrist. If it’s irregular, I trust my fingers to feel that, not the monitor. The rate though, I will do a rough estimation to make sure the pulse ox is in the right ballpark, and if it is, then I know I can trust the monitor. If it’s off on the other hand, I will continue feeling to try to find out what strange anomaly is causing the monitor to mis-count.

    There’s always good old manual counting and a watch, which I can do in 15 seconds, but if the monitor can confirm the rate, I can spend my time feeling out whether the pulse is regular/irregular, and looking for other signs of circulation or even visualizing/counting the respirations while I’m “pretending” to count the patient’s pulse.

    *shrug* I haven’t completed my Paramedic Certs yet, but I feel that there is a place for monitors to back up what we can check manually with our own 5 senses.

    (Not sure why I commented… the button was there and it kept whispering to me “click me, CLICK ME.”– Wait. I’m not supposed to tell you that!)

    Great article guys. Maybe some of those brand new EMT grads will read it before trusting an SPo2 on someone with poor circulation, cold fingers or any number of other reasons why an SPo2 could give a false reading.

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