A pulse oximeter is a non-invasive device used to measure oxygen saturation and heart rate. It works by shining two wavelengths of light through tissues like a finger or earlobe to determine the ratio of oxygenated to deoxygenated hemoglobin in the blood. Normal oxygen saturation is between 95-99% but can be lower in conditions like COPD or circulatory issues. If saturation is low, actions like increasing oxygen delivery or checking ABCs (airway, breathing, circulation) may be needed. The device provides useful information but can be affected by factors like low blood flow, so clinical judgement is also important.

1. Background Hemoglobin Gas Exchange and Respiration

2. HEMOGLOBIN Hemoglobin (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.

3. HEMOGLOBIN (continue)

4. Gas exchange and respiration

5. Gas exchange and respiration

6. 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

7. TYPES OF OXIMETERS Designs: Pulse Oximeter as part of an anesthetic machine A portable desktop unit A finger/mobile pulse Oximeter

8. Pulse Oximeter as part of an anesthetic machine

9. Pulse Oximeters (continue) Desktop Finger/mobile

10. 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).

11. Pulse Oximeters may be used in patients: Undergoing surgical procedure under general anesthesia Undergoing surgical procedure under conscious sedation

12. 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

13. 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

14. 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

15. 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

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

17. 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.

18. 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.

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

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

21. 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?

22. 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

23. 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

24. 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

25. Q4 What happens to the Pulse Oximeter reading of a patient immediately after a respiratory arrest? The saturations decrease until cardiac arrest occurs

26. Q4 What happens to the Pulse Oximeter reading of a patient immediately after a respiratory arrest? The saturations decrease until cardiac arrest occurs

27. 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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