I wouldn’t lose a minute of sleep….

….if every Sp02 monitor disappeared off the face of the earth.

Nurse: “What’s the patient’s O2 Sat?”

Medic: “We brought him in BLS, didn’t use the Spo2″

Nurse: “Why didn’t you use the Sp02?”

Medic: “The patient doesn’t present with any respiratory distress. His skin signs are pink, warm and dry, his lung sounds are clear and he speaks in full sentences without difficulty”

Nurse: “But why didn’t you get an O2 Sat?”

Sound familiar?

I am of the strong opinion that we could easily do our job without ever touching an Sp02 monitor. One of the beauties of EMS is that we still do physical assessments on our patients and don’t rely on numbers on a screen to tell us if our patient’s are sick. Well, at least most of us don’t.

Technology is great, but it shouldn’t replace a physical assessment. We should be able to tell that our patient is having difficulty breathing long before the Sp02 monitor ever leaves the bag. Tools like the Sp02 monitor are supposed to help establish a baseline, monitor effects of treatment and tell us what we already know. And for that purpose it works great.

It absolutely drives me nuts when I see people get all worked up for the sole purpose that a patient’s Sp02 reading is low. If the patient’s presentation doesn’t match the reading, then guess what? The machine is wrong. Most people wouldn’t start pacing someone, or even administer any medications to someone with a heart rate of 40 if they were asymptomatic. So what is it about the Sp02 reading that gets people all worked up?

Unfortunately on the flip side of this scenario, I often see people downplay someone’s condition because the Sp02 reading is within normal limits. It all goes back to treating the patient and not the numbers. I can’t help but to look down and shake my head when I see a crew bring in a patient with labored breathing on room air, because “she’s sating 98%”. One of my “favorites” is when I get a response like this: “Why is he on a non-rebreather? He’s sating 99%”.

If you want to treat numbers, then go be a mathematician.

Future Ditch Doctor

Amen. At work at get called to a nursing home in the area regularly for patients with “low ‘stats’” and it’s maddening when we pick the patient up, they present normally and then they wonder why we’re bringing them back from the ER an hour or so later with a report of “no abnormal findings” from the doc. One of my medic instructor’s favorite sayings is “treat the patient, not the equipment.” I couldn’t agree more.
Donnasweeten

I totally agree with you, what in the world did we do before they invented that little machine? We assessed our patients.
Point in case…. call to a nursing home…. pt has o2 sats in the 70′s. We run there hot, go in, go to the patients room and he’s not in his room. So they start looking and we finally find him on another hall walking at a fairly fast clip. He says good morning how are you fine folks today? He’s pink warm dry and in no way in any distress respiratory or otherwise. We check his o2 sats and they’re 97. Pt says there’s nothing wrong, The nurse says he looked fine, but his sats were terrible. Upon further questioning, pt had gone outside to smoke, and it was fairly cold outside, when he came back in she took his vitals. LOL
Ladyd330

Is that like why didnt you get a blood sugar on a pt who is a&o gcs-15 and is complaining of foot pain???
- Too Old To Work
  
  Pretty much. It’s stupid stuff that triage nurses have to do so they think that we should to it for them.
http://twitter.com/emtgirl Renee Roberts

While we carry pulse oximeters, I make it a point to tell my staff to look at how our patient in presenting, if they are improving, getting worse, etc. Cold days, wet athletes, someone shivering (even due to fever), fingernail polish… all of these (and more) affect accuracy of a pulse ox. I am one of those wonderful people who shows a great pulse ox, even though I am clearly dyspneic when I am having an asthma attack. I decompensate quite rapidly. This happened in front of two of my staff one day. Later, I used it as a teaching exercise on why we treat the patient, not the monitor.
- http://twitter.com/emtgirl Renee Roberts
  
  And also why ANYONE can become a patient at ANYTIME.
Too Old To Work

I mostly agree with you. O2 sats in and of themselves are useless. My sat runs about 95 or so on room air. Sometimes it drops to 93, sometimes it’s as high as 97. I don’t have any respiratory disease, can climb stairs with the young guys, and ride my bike without difficulty.

OTOH, the AHA along with the British Thoracic Society have adopted positions that Oxygen therapy should be withheld or limited in patients with O2 sats greater than 94 or so. According to them, the science shows that supplemental Oxygen doesn’t help patients because the problem is not lack of Oxygen, but lack of ability to ventilate. Which is why we are seeing a move towards low flow O2 for most patients, and will see a move towards room air resuscitation and using compressed air instead of compressed Oxygen for nebulized medications.

Personally, I put most patients on a NC since they tolerate it better and it’s easier to hear them when they speak.

Oh, if you really want to screw with a nurse, tell her you don’t have a sat reading, but can give her an ETCO2 reading. They have NO idea what to do with that because EDs generally don’t have capnography or capnometry for non intubated patients.

I wouldn’t lose a minute of sleep….

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