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Permalink Reply by John Crabbe on February 1, 2012 at 11:15am

For the most part I haven't seen any issues with any pulse ox devices. I have seen and used a few varieties, the small, one finger units, the boxier units, the pulse ox connected to a cardiac monitor, and all get the job done. Any issues are pretty easily corrected, most being a battery issue.

 

The ONLY issue is if the pulse ox does not measure CO. If you have a victim of smoke inhalation or CO poisoning and your pulse ox doesn't detect CO...then you can get a high O2 sat reading which is going to be misleading. Other than that, get what ever device works for you.

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Permalink Reply by Jennifer King on February 1, 2012 at 2:21pm

I haven't seen any issues w/ the pulse ox devices either.We use ours on most every medical call. We have the hand held units on our BLS trucks and SaO2 that plugs into our LifePak 12's on the ALS units. If a department is on a tight budget, I'd go with a less expensive model for sure. When it comes down to it, everyone has to remember to treat the patient, NOT the machine. As you well know, a 2 pack a day smoker can easily register 98%. The devices w/ CO are awesome, but expensive. If a patient is found inside a burning house, they'll get treated the same by me whether I know their CO levels or not.And as far as having it for your FF's....it's much cheaper  AND safer to strongly enforce safety & proper PPE at all times. We have actually enacted new SOP where the Battalion Chief on a fire scene has to use an air monitor to check PPM before masks can come off for salvage & overhaul...

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Permalink Reply by Marc Hansen on February 1, 2012 at 11:29pm

2 biggest problems with pulse ox's have nothing to do with the equipment

1)  People are lazy and use the reading on the SpO2 instead of actually palpating a pulse

2) for the regular SpO2 units with no CO reading everyone forgets that after CO exposure SpO2 levels will probably be in the normal range, but the reading is misleading due to the way the units measure O2 levels. Not just Fire/EMS but ER staff forgets, I've been yelled at for bringing pt's in from CO calls (where our CO detectors have activated) without pulse ox on the patient.

Sometimes with all of the technology we all get caught up in treating the equipment and not the patient
 

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Permalink Reply by Olivia Jones on February 2, 2012 at 12:23am

Marc I couldnt agree more with your number one reason. The other thing we deal with is because the newer guys use the pulse ox for everything they arent actually counting resp rate. This drives me nuts! feeling an pulse and counting resp are the first 2 things I do on scene.

 

the only other issue I have found is the SpO2 meters my dept has bought and I know it is more of a model issue than anything else is cold hands give you a bad reading if any, and my dept wont get one with a peds adapter so on peds calls you hope for the best. But I fully understand that there are meters out there that would eliminate those problems.

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Permalink Reply by John Crabbe on February 2, 2012 at 12:31am

my dept wont get one with a peds adapter so on peds calls you hope for the best.

 

Try putting the adult probe on the child's toe....this tends to work well even with smaller children. Also, pulse oximetry on a child is NOT a critical factor. Children tend to compensate more for their injuries and a pulse ox is not a good indicator of problems. Instead of pulse oximetry a better indicator of perfusion for a peds is capillary refill...within 2 seconds, they are perfusing fine.

 

Another aspect is too much oxygen can be bad for a child, especially newborns. Listen to lung sounds, get cap refill, if there is some O2 indicated, blow by works fine, but having a peds pulse ox probe is not that important of a tool.

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Permalink Reply by Marc Hansen on February 2, 2012 at 8:37pm

not a model issue but a circulation issue...extremities getting colder first as the body starts to shunt blood and oxygen to the core, try placing the probe on an earlobe they tend to stay a little warmer and the readings will be close

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Permalink Reply by Ben Waller on February 2, 2012 at 9:27pm

We have PhysioControl Lifepak 12's with the Pulse Ox (SPO2) and End-Tidal Capnography upgrades.  We run ALS transport as well as Fire-Rescue, and the Medic companies all carry these.

 

We also have one RAD 57 carried by by the Battalion Chief.

 

Problems with Pulse Ox isn't just limited to false positives in Carbon Monoxide (CO) cases.  Cyanide Poisoning or smoke inhalation with high cyanide levels (Cyanohemoglobin) and conditions that cause Methemeglobinemia (Crush Syndrome, some kinds of sepsis, severe skeletal muscle injuries)  can also skew Pulse Ox readings.

 

We use Pulse Ox many times per shift - it's a routine "4th Vital Sign" for us.

We use the RAD 57 primarily for monitoring firefighters during Rehab at working fires.  We also use it to monitor smoke inhalation patients or patients at CO alarm calls as needed.

 

As others have stated, there are things that can make Pulse Ox readings inaccurate;  Cold extremities, burns at the probe site.  By far the most common is fingernail polish - the probe can't read SP02 through opaque surfaces and it is affected by even clear fingernail polish.  We carry Acetone Preps (look like alcohol preps but have the active ingredient in fingernail polish remover) for this.  A few quick swipes on one finger, dry the fingernail off with a tissue or by evaporation, and use the now-clear fingernail for the SPO2 reading.

 

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Permalink Reply by Olivia Jones on February 2, 2012 at 11:15pm

Good point on the nail polish Ben also women that have artificial nails even with the polish off you have that problem.

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Permalink Reply by Jina Lee on February 3, 2012 at 10:49am

Thank you for all the response. It seems that a pulse-oximeter is a great tool to use but it has its own limitations just as any other tool would. 

Another quick question:

What kind of accidents do you guys face the most when out on a call? What kind of injuries on victims do you witness the most?

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Permalink Reply by Marc Hansen on February 4, 2012 at 4:27pm

from bar closing time to about 0300-> alcohol induced

after 0300 when im trying to sleep -> stubbed toes, sore knees all at least 12 hours since injury

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