{"id":473,"date":"2013-03-16T12:31:24","date_gmt":"2013-03-16T12:31:24","guid":{"rendered":"http:\/\/drcrunch.wordpress.com\/?p=473"},"modified":"2013-03-16T12:31:24","modified_gmt":"2013-03-16T12:31:24","slug":"the-sats-probe-is-not-god","status":"publish","type":"post","link":"http:\/\/drcrunch.co.uk\/blog\/2013\/03\/16\/the-sats-probe-is-not-god\/","title":{"rendered":"The sats probe is not God"},"content":{"rendered":"

\u201cDoctor, can you come see this patient please?\u201d<\/p>\n

\u201cWhat\u2019s happened?\u201d<\/p>\n

\u201cHer saturations keep dropping. We keep moving the probe but the best we get is 82%.\u201d<\/p>\n

\u201cWhat were her saturations like an hour ago?\u201d<\/p>\n

\u201cOh, you know, around 95, 96 on air.\u201d<\/p>\n

\u201cHow does she look?\u201d<\/p>\n

\u201cShe looks distressed\u201d<\/p>\n

\u201cOK, be there in a bit. Put high flow oxygen on.\u201d<\/p><\/blockquote>\n

It\u2019s always the patients on the furthest ward from where you are. There\u2019s this corridor on the way from Day Surgery unit to the rest of the hospital which has three glass walls and the floor. This looks lovely in the day, but it\u2019s Siberia during the night. There is a door at either end of this corridor. You can leave Day Surgery through the first one, but the probability of the distal door being locked is determined by the product of how cold you are and how urgently you need to get through.<\/p>\n

When I got there, I saw a slightly breathless 75 year old lady who was asking me \u00a0what all the commotion was about. She said she felt a little SOB, but not massively. Her RR was 18. The chest was clear.<\/p>\n

Her radial pulse felt inconsistent. Her cap refill was less than two seconds, her BP 108\/70 and her pulse 100 and irregular.<\/p>\n

An ECG showed atrial fibrillation. This was new for her.<\/p>\n

She had been admitted for a Hartmann\u2019s procedure and was day 1 post operatively.<\/p>\n

I felt that the saturations did not match up with the clinical picture, so did an ABG which showed a pO2 of 44.3 kPa. This showed that the saturations were misleading.<\/p>\n

I later discussed this with the medical registrar. He told me that one of the commonest explanations for fluctuating<\/em> saturations is atrial fibrillation. He also told me to always check the probe on my own finger if the clinical picture does not match up with the saturations.<\/p>\n

We started her on bisprolol 1.25mg OD. She was already warfarinised for a previous PE.<\/p>\n

Bottom line: Always go with your clinical impression over the sats machine, and get an ABG if in doubt.<\/p>\n

Good links:<\/p>\n

The WHO<\/a> has guidance on pulse oximetry which mentions arrhythmias as a cause of false readings.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u201cDoctor, can you come see this patient please?\u201d \u201cWhat\u2019s happened?\u201d \u201cHer saturations keep dropping. We keep moving the probe but the best we get is 82%.\u201d \u201cWhat were her saturations…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"spay_email":"","footnotes":"","jetpack_publicize_message":""},"categories":[1],"tags":[],"class_list":["post-473","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"jetpack_featured_media_url":"","jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p9zRNY-7D","jetpack_likes_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/posts\/473","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/comments?post=473"}],"version-history":[{"count":0,"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/posts\/473\/revisions"}],"wp:attachment":[{"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/media?parent=473"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/categories?post=473"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/drcrunch.co.uk\/blog\/wp-json\/wp\/v2\/tags?post=473"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}