Emergency pulse oximeter

[rjack321]

Please explain what advantage knowing pulse O2 in the field will provide for one administering first aid on site for dive related issue (not talking about EMS)?

If one has O2 to administer then it should be administered, if one does not have O2 to administer then one can ponder obtaining/purchasing O2 for the future while administering other first aid protocols.

What would you expect a first responder to do differently knowing pulse O2 levels that they would not already be doing?

The tendency with gadgets like this is tunnel vision, where the responder spends more time looking at what the device is indicating and thinking about how they should respond to it than just provide sound first aid based on established protocols.

Your money is better spent on CPR/First aid/O2 Administration certification or recertification than on pulseoximeter.

Knowing pulseO2 changes nothing in the field from a first responder/patient care perspective. In fact responding specifically to PO2 levels indicated by pulseoximeter by first responder who does not have more advanced medical/emergency response training can open the first responder to liability issues for administering care beyond their training. If the OP fell into the category of advanced medical/emergency response they would not have asked the question in the first place.

Bottom line is that one can spend their money on any gear/equipment/gadget they want, but there really is nothing useful or practical that a pulseoximeter and it’s readings bring to a first responder scenario…perhaps use that money to invest in a portable AED, much more useful when the occasion for use presents itself.

-Z

bUt wE LiKE gADgets!

Yeah I am struggling to relate a pulse oximeter to any dive related or exercise related injury or their treatment in the field. It could even cause more harm than good if the meter readings take precedence over the patient history
"Diver ascends and has a skin rash which fades and then pain in their elbows gets put on high flow O2 with a pulse oximeter"

Next caregiver in the EMS train skips over the word diver, but loves that you already have a oximeter on their finger "oh O2 sat is fine on room air, we'll just remove this high flow O2 mask then" Eeeps.

Divers can have a hard enough time getting patients on O2 consistently, no need to make that argument more complicated. An AED is 20x the cost and weight but way more life or death.

 

[TravelGas]

Please explain what advantage knowing pulse O2 in the field will provide for one administering first aid on site for dive related issue (not talking about EMS)?

If one has O2 to administer then it should be administered, if one does not have O2 to administer then one can ponder obtaining/purchasing O2 for the future while administering other first aid protocols.

What would you expect a first responder to do differently knowing pulse O2 levels that they would not already be doing?

The tendency with gadgets like this is tunnel vision, where the responder spends more time looking at what the device is indicating and thinking about how they should respond to it than just provide sound first aid based on established protocols.

Your money is better spent on CPR/First aid/O2 Administration certification or recertification than on pulseoximeter.

Knowing pulseO2 changes nothing in the field from a first responder/patient care perspective. In fact responding specifically to PO2 levels indicated by pulseoximeter by first responder who does not have more advanced medical/emergency response training can open the first responder to liability issues for administering care beyond their training. If the OP fell into the category of advanced medical/emergency response they would not have asked the question in the first place.

Bottom line is that one can spend their money on any gear/equipment/gadget they want, but there really is nothing useful or practical that a pulseoximeter and it’s readings bring to a first responder scenario…perhaps use that money to invest in a portable AED, much more useful when the occasion for use presents itself.

-Z

That’s a lot of questions, I will do my best to address all.

A pulse ox is a very useful diagnostic tool. What do all of the following have in common
Patient’s beside monitor in a hospital room
LIFEPAK 15 on the ambulance
$25 Pulse Ox from CVS

They all have a probe that monitors the O2 level in the patients tissue and that is a key indicator of your patients oxygenation/perfusion status. Without the Pulse Ox, you would have to rely on signs (things you can see) like blue lips or the Patients mental status has become altered. Both of those are late signs that inadequate perfusion is happening.

I see no issue whether a FA provider has a Pulse Ox or not, they are sold over the counter, but there are legal liability issues to purchasing, possessing and administering O2. The Good Samaritan law only protects the provider who is operating within their level of training and is meeting the Standard of Care. Read, do no harm.

How can we in the field help fix that before late signs are apparent? If we have a pulse ox and the PO2 reading is below 94% we give oxygen. Current protocols are no longer that every Pt. get O2, nor we give O2 at 95%or below, the latest protocol is below 94%.

I don’t know that it makes any difference if we are talking about a dive related issue or EMS. The patient either needs O2 and ventilatory support or they do not. In a dive boat related setting, where a long travel time to get the patient to the next level of care, because the area the boat is operating in and can not get a medievac to remove the Patient quickly, knowing the O2 sat’ level can be even more important, since on a dive boat there is finite/limited amount of O2 on board and you want to use that supply when the patient needs it, if their condition is worsening and not waste it when they are perfusing adequately and do not need O2. Giving O2 when its needed to a person who is in shock is an important treatment to getting your patient out of shock or delaying the onset of decompensating shock.

As for the possession of an Medical grade O2 and the proper masks to deliver it to the patient. Oxygen is an FDA regulated drug that requires either a Doctors prescription or a Medical license in order to purchase it and possess it. Typically, if not on the bus and the Medic wants O2 for their own kit, you go to a welding supply vendor they take a copy of your EMS license, vet you with the state , open an account for you and fill your tank with medical grade O2. So, anyone who just wants to have O2 for their first aid kit, can not have it, since they lack the proper training and license to legally obtain it.

As for the AED, while having one and the proper training to use it is great, an AED is also regulated. To legally possess an AED, at least in my state, you must either have a prescription from a Doctor or have an EMS license to legally purchase one. Of course, anyone can buy anything they want on Ebay. If we are concerned about the cost of a $25 Pulse Ox breaking the bank, then how can one purchase a $1,000-1,500 AED along with the items needed to use an AED and maintain it, i.e. (Fast Response kit) Pocket Mask, scissors, gloves, safety razor, small towel. Let’s not overlook CPR / AED certification which expires every 2 years. Then you must replace the AED battery every 2 years or less $150 and you need 2 sets of AED pads @ $75 each set, which also expire every 2 years. Also, not a bad idea to buy a Pelican box to put your AED and fast response kit in, so that the AED will be protected from damage and working, when it is finally needed.

Since we are talking about a dive related medical emergency, lets say for example you have a patient who has an air embolism which has lodged in the Pulmonary Artery which carries deoxygenated blood from the heart to the lungs. Now as this embolism/blockage restricts the flow of deoxygenated blood into the lungs, which will also reduce the flow of oxygenated blood to the body, which is Obstructive Shock, wouldn’t you want to know that the amount of oxygenated blood in the container is being reduced and your patient is becoming hypoxic? The pulse ox will indicate that trend.

Another advantage of the pulse ox is that for the lone medical provider who only has two hands, once determining by comparing a pulse taken by palpation and compared to the pulse rate that is also shown on a pulse Ox is accurate, you no longer have to take 15-30 seconds every 5 minutes to take your patients pulse by palpating, you can get it from the pulse ox, this allows you to work on other injuries or tasks, since you do not have to tie up one hand for 15-30 seconds every 5 minutes, that this patient requires their vitals to be taken.

I am not a Dive Medicine Doctor. I believe training always trumps equipment. I have seen many times on this forum people say Tech diving is not cheap and if you cant afford it, you should not be doing it. Well, setting up a Trauma bag or getting the proper training is not cheap either and among the cheapest things that you will buy for your kit to stock it, is a $25 pulse ox diagnostic tool. For reference, today’s prices a box of band aids is $10.

 

[kelemvor]

$25 well spent addition to any Trauma kit.

Just say no to the cheap ones, unless they've been approved by FDA or similar agency from another country.

Many of the cheap ones are unreliable, and you've got no way to know if yours is reliable save FDA or equivalent approval

Citation: Sci-Hub | The Accuracy of 6 Inexpensive Pulse Oximeters Not Cleared by the Food and Drug Administration. Anesthesia & Analgesia, 123(2), 338–345 | 10.1213/ANE.0000000000001300

 

[TravelGas]

An example of a properly set up and maintained up AED.

 

[Zef]

Since we are talking about a dive related medical emergency, lets say for example you have a patient who has an air embolism which has lodged in the Pulmonary Artery which carries deoxygenated blood from the heart to the lungs. Now as this embolism/blockage restricts the flow of deoxygenated blood into the lungs, which will also reduce the flow of oxygenated blood to the body, which is Obstructive Shock, wouldn’t you want to know that the amount of oxygenated blood in the container is being reduced and your patient is becoming hypoxic? The pulse ox will indicate that trend.

Your example presents a case where if you have O2 you should administer it, and if you don’t you obviously can’t…there is nothing in this scenario that you present that a pulseoximeter will help you to be able to render better first aid care in the field from any practical standpoint. With/without knowing PO2 you should activate EMS as early as possible, stabilize victim, treat for shock, treat any apparent injuries, monitor overall condition, and if possible/necessary transport to facilitate meeting EMS (e.g., get the boat ashore to rendezvous with ambulance asap).

Knowing whether the victim is hypoxic or not is irrelevant from a first aid treatment standpoint, you treat for it regardless if suspected or known and have the resources (O2) available.

A first aid provider does not diagnose a victim, they make an assessment of the victims condition, stabilize/treat injuries to the best of their ability within the standard of their care. First aid providers do not “diagnose” they “assess”.

Another advantage of the pulse ox is that for the lone medical provider who only has two hands, once determining by comparing a pulse taken by palpation and compared to the pulse rate that is also shown on a pulse Ox is accurate, you no longer have to take 15-30 seconds every 5 minutes to take your patients pulse by palpating, you can get it from the pulse ox, this allows you to work on other injuries or tasks, since you do not have to tie up one hand for 15-30 seconds every 5 minutes, that this patient requires their vitals to be taken.

As a former military medic, EMT, and BLS/first aid instructor, with a degree in Athletic Training, I can’t think of a scenario in a first aid provider scenario where one needs to palpate an accurate pulse every 5 minutes. From a cpr perspective one would be dealing with an unconscious victim and it is only necessary to asses I if a pulse is present not how many bpm the pulse is, if the pulse is present then stabilize and treat for shock, treat other injuries, monitor and ensure victim’s airway is open, and administer rescue breathing if necessary….since one cannot be breathing without a pulse there is no need to know what the pulse is, just keep rendering first aid to stabilize the victim and get them to more advanced EMS care. If they are not breathing then ones still does not need to know exact pulse, only if one is present to know if rescue breathing or cpr is warranted. During CPR the protocol is to recheck for pulse after each 4 cycles of breaths/compressions…this is not the time to look at the pulseoximeter, you are expected to palpate, and it does not matter what the pulse is, only that it is present or not. In any other situation you really only need to know if the pulse is rapid, strong, weak, thready…but even then, regardless of pulse characteristic it is not wrong to treat for shock, and monitor and stabilize. One does not need to keep checking the pulse or have a gadget indicating the pulse to assess if the victims condition is worsening and from a first aid /BLS standpoint it doesn’t matter…if victim is breathing then stabilize and treat for shock, administer O2 if available, if victim is not breathing but has pulse then administer rescue breathing, stabilize victim, treat for shock. If no pulse then administer cpr, etc, etc. Actual pulse is not important from a first aid standpoint, only if one is or is not present.

If one is dealing with trauma, the first priority is whether the scene is safe to administer aid. After that, the priority for a conscious victim
Is to stabilize (treat apparent injuries), treat for shock and get them to more advanced care. For an unconscious victim the priority is to check and maintain an open airway to facilitate breathing, stabilize/treat apparent injuries, treat for shock, and get them to more advanced care.

Administer O2 if you got it and it is safe to do so, especially in DCI/DCS scenarios…actual pulse count or present pulse-ox is superfluous to rendering/providing first aid.

Again, buy one of you want, as they are inexpensive and available, but in answering the OP’s questions, a Pulseoximeter offers no practical benefit to one administering O2 in a first aid scenario, and EMTs/Paramedics will attach one to the victim/patient as either a part of their protocols or judgement, and since the readout is fairly rapid, there is no need for someone rendering first aid to apply this device and track in advance of advanced emergency medical response’s arrival on scene.

“Hi All, Wondering if the purchase of a finger pulse oximeter would be a good addition to our clubs oxygen kit. In the case of having to administer O2 would the reading be helpful in monitoring the delivery of O2. Would it be something that a paramedic or diving specialist doc need to know in assessing patients symptoms?”

-Z

 

[TravelGas]

Your example presents a case where if you have O2 you should administer it, and if you don’t you obviously can’t…there is nothing in this scenario that you present that a pulseoximeter will help you to be able to render better first aid care in the field from any practical standpoint. With/without knowing PO2 you should activate EMS as early as possible, stabilize victim, treat for shock, treat any apparent injuries, monitor overall condition, and if possible/necessary transport to facilitate meeting EMS (e.g., get the boat ashore to rendezvous with ambulance asap).

Knowing whether the victim is hypoxic or not is irrelevant from a first aid treatment standpoint, you treat for it regardless if suspected or known and have the resources (O2) available.

A first aid provider does not diagnose a victim, they make an assessment of the victims condition, stabilize/treat injuries to the best of their ability within the standard of their care. First aid providers do not “diagnose” they “assess”.




As a former military medic, EMT, and BLS/first aid instructor, with a degree in Athletic Training, I can’t think of a scenario in a first aid provider scenario where one needs to palpate an accurate pulse every 5 minutes.

During CPR the protocol is to recheck for pulse after each 4 cycles of breaths/compressions…this is not the time to look at the pulseoximeter,

-Z

Here is the AHA CPR Guidelines updated for 2021. There is no mention of checking pulse after 4 cycles of CPR, as you stated. That went out of protocol a long time ago. I don’t know if the credentials you listed are current and refreshed, protocols do change all the time.

https://www.dchosp.org/images/2021-CPR-quick-study-guide.pdf

I never said during CPR one should check a pulse ox, nor did I ever say “if you have O2 then use it”. One of the advantages of having a pulse ox is so that you can assess if O2 is needed, or not to administer O2. The days of all Trauma Patients get O2 is also long over. I also never said that I make diagnosis, I leave that to the ED Doctors.

For National Registry practical skills testing for all levels EMT, AEMT and Paramedic, if you do not correctly state in the Trauma Patient Assesment station that vitals will be taken every 5 minutes you will lose a point in the reassessment section, not a critical failure, but a point deduction. If your EMT cert’ is no longer current, you can google how often Trauma Patient vitals are taken and it is easy to find “every 5 minutes”.

Well, I can see we disagree and you are free to do or believe whatever you like.

 

[GJC]

Hi All, Wondering if the purchase of a finger pulse oximeter would be a good addition to our clubs oxygen kit. In the case of having to administer O2 would the reading be helpful in monitoring the delivery of O2. Would it be something that a paramedic or diving specialist doc need to know in assessing patients symptoms?

A pulse oximeter may be helpful in some medical emergencies if you are trying to extend your oxygen supply to last a longer time. It would not be helpful for treating diving emergencies.

Remember that for decompression illness and arterial gas embolism, the primary reason for giving oxygen is not to deliver more oxygen to tissues. It is to reduce the partial pressure of nitrogen. By reducing inhaled nitrogen, nitrogen in the blood stream is reduced and this helps move nitrogen out of bubbles faster (reducing bubble size).

The lower the nitrogen in the blood stream is, the faster it moves from the bubbles. The easiest way to do this is to give as close to 100% oxygen as possible.

So for diving medical emergencies:

GIVE AS HIGH A CONCENTRATION OF OXYGEN AS POSSIBLE UNTIL THE SUPPLY RUNS OUT. Do NOT reduce oxygen delivery to try to extend your supply. Do NOT reduce oxygen delivery based on pulse oximeter readings.

 

[Zef]

Here is the AHA CPR Guidelines updated for 2021. There is no mention of checking pulse after 4 cycles of CPR, as you stated. That went out of protocol a long time ago. I don’t know if the credentials you listed are current and refreshed, protocols do change all the time.

https://www.dchosp.org/images/2021-CPR-quick-study-guide.pdf

I never said during CPR one should check a pulse ox, nor did I ever say “if you have O2 then use it”. One of the advantages of having a pulse ox is so that you can assess if O2 is needed, or not to administer O2. The days of all Trauma Patients get O2 is also long over. I also never said that I make diagnosis, I leave that to the ED Doctors.

For National Registry practical skills testing for all levels EMT, AEMT and Paramedic, if you do not correctly state in the Trauma Patient Assesment station that vitals will be taken every 5 minutes you will lose a point in the reassessment section, not a critical failure, but a point deduction. If your EMT cert’ is no longer current, you can google how often Trauma Patient vitals are taken and it is easy to find “every 5 minutes”.

Well, I can see we disagree and you are free to do or believe whatever you like.

First...My EMT training was back in the mid-90s. The word "former" was meant to apply to military medic, EMT, and BLS/First Aid instructor.

Second...if you dig deeper into the AHA protocols for Basic and Advance life support you will find that for laypersons the recommendation is to not take a pulse and start chest compressions if it is suspected that the victim is in cardiac arrest, is it has been ascertained that the risk of damage to a victim who does not need compressions is minimal compared to the urgency of need in the victim that does need chest compressions......
......Additionally for a trained medical provder, the algorithm is to spend no more than 10 seconds palpating a pulse before commencing chest compressions and to recheck every 2 minutes...since single person CPR is cycles of 30 compressions followed by 2 breaths, checking pulse every 2 minutes of CPR syncs up with checking for pulse every 4 cycles.

I agree to disagree on the usefulness of a pulse oximeter for first aid scenarios....in my experience it offers no useful information and is just a distraction. Your responses do not really do anything to address the OP's questions.

My recommendation and logic dictates, that if one has O2 available in a first aid emergency situation, and it is safe to administer, then one should if physiological signs warrant it....if treating for shock for shock. Once does not need to know pulse-ox percent to know that a victim is suffering from shock, (and yes I know you have not stated that) there are more relevant signs that application of O2 is warranted without the use of a device that may not give an accurate reading....in the case of inaccurate reading one could argue that no harm is being done in the application of O2, but that follows the logic to just administer it and skip the gadget.

And as has been repeated by a few folks in this discussion thread: in diving medical emergencies (suspected DCI/DCS) the protocol is to give O2 if available and safe to administer (meaning no explosion hazard is present in proximity to the area of treatment).

And for the sake of clarity, I have maintained that one can spend their money how they want, but while a pulse oximeter will provide information it is not really information that is of use to the lay-first responder rendering first aid.

-Z

 

[PfcAJ]

First...My EMT training was back in the mid-90s. The word "former" was meant to apply to military medic, EMT, and BLS/First Aid instructor.

Second...if you dig deeper into the AHA protocols for Basic and Advance life support you will find that for laypersons the recommendation is to not take a pulse and start chest compressions if it is suspected that the victim is in cardiac arrest, is it has been ascertained that the risk of damage to a victim who does not need compressions is minimal compared to the urgency of need in the victim that does need chest compressions......
......Additionally for a trained medical provder, the algorithm is to spend no more than 10 seconds palpating a pulse before commencing chest compressions and to recheck every 2 minutes...since single person CPR is cycles of 30 compressions followed by 2 breaths, checking pulse every 2 minutes of CPR syncs up with checking for pulse every 4 cycles.

I agree to disagree on the usefulness of a pulse oximeter for first aid scenarios....in my experience it offers no useful information and is just a distraction. Your responses do not really do anything to address the OP's questions.

My recommendation and logic dictates, that if one has O2 available in a first aid emergency situation, and it is safe to administer, then one should if physiological signs warrant it....if treating for shock for shock. Once does not need to know pulse-ox percent to know that a victim is suffering from shock, (and yes I know you have not stated that) there are more relevant signs that application of O2 is warranted without the use of a device that may not give an accurate reading....in the case of inaccurate reading one could argue that no harm is being done in the application of O2, but that follows the logic to just administer it and skip the gadget.

And as has been repeated by a few folks in this discussion thread: in diving medical emergencies (suspected DCI/DCS) the protocol is to give O2 if available and safe to administer (meaning no explosion hazard is present in proximity to the area of treatment).

And for the sake of clarity, I have maintained that one can spend their money how they want, but while a pulse oximeter will provide information it is not really information that is of use to the lay-first responder rendering first aid.

-Z

For the sake of accuracy, every 2 mins is rhythm check, not pulse check by the newest ACLS algorithm. If you have signs of ROSC (non shockable rhythm, abrupt increase in ETCo2, and subsequent BP and pulse) then move to post arrest care.

No sense in feeling for a pulse (and having time off the chest) if you can look at the monitor and see vfib or v tach.

AEDs will ask for pulse check because they can’t really tell between PEA and a perfuming rhythm.

 

[dmaziuk]

Just say no to the cheap ones, unless they've been approved by FDA or similar agency from another country.

Many of the cheap ones are unreliable, and you've got no way to know if yours is reliable save FDA or equivalent approval

Citation: Sci-Hub | The Accuracy of 6 Inexpensive Pulse Oximeters Not Cleared by the Food and Drug Administration. Anesthesia & Analgesia, 123(2), 338–345 | 10.1213/ANE.0000000000001300

+1: I went through a number of different reviews back when the virus started and came to the conclusion that if your $25 pulse oximeter shows low O2 sat, it most likely means your pulse oximeter is junk. We still don't have one at home, for that reason.