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For the EMT-Basic
Objectives Understand ALCO regulations relative to monitoring
pulse oximetry by the EMT-B
Review the signs and symptoms of respiratory compromise.
Understand the importance of adequate tissue perfusion.
Understand circumstances that hinder/prevent SpO2 readings.
ALCO Regulations Protocol pg. 47
Allows EMTs to monitor saturation of arterial oxygen levels of blood by way of pulse oximetry.
Falls under “Baseline vital signs”
What is it used for?
Respiratory Compromise Signs and Symptoms
Dyspnea
Accessory muscle use
Inability to speak in full sentences
Adventitious breath sounds
Increased or decreased breathing rates
Shallow breathing
Flared nostrils or pursed lips
Retractions
Upright or tripod position
Hypoxemia Causes lower oxygenation in arterial blood
Results in decreased cellular oxygenation
Anaerobic metabolism
Creates energy through the combustion of carbohydrates in the absence of oxygen
Loss of cellular energy production
Hypoxemia Etiology Inadequate External Respiration (in lungs)
Decreased on-loading of oxygen at pulmonary capillaries
Inadequate Oxygen Transport
Decreased oxygen carrying capacity
Inadequate Internal Respiration (in Metabolizing tissue)
Decreased off-loading of oxygen at cellular capillaries
What are some causes of Hypoxemia?
Inadequate Oxygen Diffusion Pulmonary edema
Fluid between alveoli and capillaries inhibit diffusion
Pneumonia Reduces the surface area of
respiratory membranes
Reduces the ventilation-perfusion ratio
COPD Air trapping in alveoli
Loss of surface area of respiratory membranes
Inadequate Oxygen Transport Anemia
Reduces red blood cells oxygen carrying capacity
Inadequate hemoglobin results in the loss of oxygen saturation
Poisoning Carbon monoxide attaches to hemoglobin more readily
preventing oxygen saturation and oxygen carrying capacity
Shock Low blood pressures result in inadequate oxygen
carrying capacity
What should I look for?
Signs and Symptoms of Hypoxemia Restlessness/ Anxiety
Altered or deteriorating mental status
Increased or decreased pulse rates
Increased or decrease respiratory rates
Decreased oxygen oximetry readings
Cyanosis (late sign)
How to Monitor Sp02
Technology The pulse oximeter has Light-emitting diodes (LEDs)
that produce red and infrared light
LEDs and the detector are on opposite sides of the sensor
Sensor must be placed so light passes through a capillary bed Requires physiological pulsating waves to measure
saturation
Requires a pulse or a pulse wave (Adequate CPR)
Measuring Sp02 Oxygenated blood and deoxygenated blood absorb
different light sources
Oxygenated blood absorbs more infrared light
Deoxygenated blood absorbs more red light
Pulse oximetry reveals arterial saturation by measuring the difference.
Oxygen Saturation Definition: Percentage of hemoglobin saturated with
oxygen
Normal SpO2 is 94-99%
Suspect perfusion compromise if less than 94% SpO2 in individuals with no known Respiratory Illness
COPD Patients should have a resting SpO2 within a range of 88%-92% per county protocols.
Conditions Affecting Accuracy What to watch for:
Fingernail polish and pressed on nails
Dark Pigmentation of skin: Apply sensor to the fingertips of these patients (upside down).
Poor circulation in elderly patients
Hypothermia
Possible CO poisoning
Diabetes
Hypotension
Interpreting Pulse OximetryAssess and treat the PATIENT not
the oximeter! Use oximetry as an adjunct to patient assessment
and treatment evaluation
NEVER withhold oxygen if the patient has signs or symptoms of hypoxia or hypoxemia regardless
of oximetry readings!
Documentation Pulse oximetry is usually documented as SpO2
Document oximetry readings as frequently as other vital signs
When oximetry reading is obtained before oxygen administration, designate the reading as “room air”
SummaryAs with all monitoring devices, the interpretation of information and response to that interpretation is
the responsibility of a properly trained technician!