BackgroundBackgroundHemoglobinHemoglobinGas Exchange and RespirationGas Exchange and Respiration

HEMOGLOBINHemoglobin

(abbreviated Hb) is the iron-containing oxygen-transport metalloprotein in the red blood cells of vertebrates. Hemoglobin transports oxygen from the lungs to the rest of the body, where it releases the oxygen for cell use.

HEMOGLOBIN (continue)

Gas exchange and respiration

Gas exchange and respiration

What is a Pulse Oximeter?A Pulse Oximeter is a device used to perform the

diagnostic procedure for determining the:

Percentage of hemoglobin (Hb) that is saturated with oxygen

The oxygen saturation (SpO2) is a measure of how much oxygen the blood is carrying as a percentage of the maximum it could carry and is sometimes referred to colloquially as the "sats" reading

The heart rate The heart rate refers to the number of times that

the heart contracts in a period of one minute

TYPES OF OXIMETERSDesigns:Pulse Oximeter as part of an anesthetic

machine

A portable desktop unit

A finger/mobile pulse Oximeter

Pulse Oximeter as part of an anesthetic machine

Pulse Oximeters (continue)Desktop Finger/mobile

What does a Pulse Oximeter tell you?

A Pulse Oximeter can detect hypoxia (too little

oxygen to fulfill the needs of the brain and body)

before a patient shows signs of becoming cyanotic

(bluish discoloration of the skin and mucous

membranes due to not enough oxygen in the

blood).

Pulse Oximeters may be used in patients:Undergoing surgical procedure under general anesthesia

Undergoing surgical procedure under conscious sedation

Pulse Oximeters may be used in patients:Emergency situations

like loss of consciousness, trauma etc.

After surgery during the recovery phase

Monitoring the blood oxygen saturation in various aviation situations

Sport applications – e.g. mountaineering

Pulse Oximeters may be used in patients: In the ICU, Pulse Oximetry is used

extensively on mechanically ventilated patients, as it can frequently detect problems with oxygenation before they are noticed clinically, as well as a valuable guide for weaning patients off ventilation and helping to assess the adequacy of a patient's oxygen therapy.

This continuing assessment process has been instrumental in the introduction of Pulse Oximeter usage within the community and homecare environment of patients suffering from a variety of heart and lung diseases and conditions

Pulse Oximeters are routinely used in certain hospital wards and in casualty departments for immediate assessment of patients

Pulse Oximeter reading may not be accurate:

Reduced peripheral pulsatile blood flow

Venous congestion (partial obstruction of the veins) of an arm or leg

Bright overhead lights, such as in an operating theatre

Shivering or significant, repeated movement of the sensor

Pulse Oximeter reading may not be accurate:

Pulse oximetry struggles to distinguish between different forms of hemoglobin, such as carboxy-hemoglobin (hemoglobin combined with carbon monoxide)

Nail varnish may cause falsely low readings with most pulse Oximeters, especially those colored blue or black

The following won’t affect the Pulse Oximeter reading:Anemia Jaundice

But what is a "normal" reading?

Firstly, we would ask "normal for whom"? A fit, healthy person should have an oxygen

saturation level between 95% & 99%. Results lower than this, and especially below 90% may be caused by problems including lung diseases, such as COPD, breathing difficulties, cigarette smoking or circulatory problems such as excessive bleeding or blood vessel problems.

How does a Pulse Oximeter Work?The measurements are obtained by simply shining two wavelengths of light (1 is a visible red beam, the other an invisible infrared beam) at e.g. the fingertip.

By measuring how much light has been absorbed by the oxygen in the blood, an oxygen saturation or “sats” reading is established and displayed as a percentage of the maximum amount of oxygen the blood could carry.

Q1 If a patient’s saturation is unacceptably low, what are your immediate actions? Check Airways, Breathing and Circulation (ABC)

Q1 If a patient’s saturation is unacceptably low, what are your immediate actions?

Check Airways, Breathing and Circulation (ABC)

Q2 An elderly patient is admitted with pneumonia and has a pulse oximetry reading of 75% breathing air. With oxygen 6L per min, saturation improves to 85%. What are the implications of this oximetry reading?

Q2 An elderly patient is admitted with pneumonia and has a pulse oximetry reading of 75% breathing air. With oxygen 6L per min, saturation improves to 85%. What are the implications of this oximetry reading?

The patient was severely hypoxic (Lack of Oxygen)

Increase oxygen flow

Q3 What happens to the pulse Oximeter reading of a patient immediately after a cardiac arrest?

The pulse would be lost (causing the alarm to sound) and the saturations will decrease

Q3 What happens to the pulse Oximeter reading of a patient immediately after a cardiac arrest?

The pulse would be lost (causing the alarm to sound) and the saturations will decrease

Q4 What happens to the Pulse Oximeter reading of a patient immediately after a respiratory arrest?

The saturations decrease until cardiac arrest occurs

Q4 What happens to the Pulse Oximeter reading of a patient immediately after a respiratory arrest?

The saturations decrease until cardiac arrest occurs

In conclusion…Pulse Oximetry is a useful modality for

assessing a patient’s pulse rate and Hemoglobin Oxygen saturation in a number of routine and emergency medical situations

The clinician should be aware of the limitations of Pulse Oximetry and the various factors that may produce a falsely low or high reading

Always keep the basics principles of medicine in mind, and keep a high level of suspicion - especially when the figures don’t make sense!

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