Oximeters

Tom Benzoni benzonit at GMAIL.COM
Tue Jan 30 20:23:29 UTC 2018


Orthopedic changes do not effect them.
Skin thickness does not but we don't use these over callused areas.
They can read black skin. Melanin has a different spectral absorption.
Very cold extremities where the capillary beds are clamped down can cause
erroneous readings as can patients in extremis from end-stage myocardial
disease...but don't need a pulse ox there.
An interesting error source comes from blood pressure cuffs. Because the
cuffs are usually set to automatic, intermittent low readings occur not
from the patient but from temporary occlusion of the artery by the cuff if
on the ipsilateral arm. If you're not aware of this error source, you can
think the patient on whom you're doing a procedure is in trouble when
they're fine. And you might terminate the procedure or make an unnecessary
intervention on a well person.
What is that type of error?

tom

On Mon, Jan 29, 2018 at 11:49 PM, robert bell <
0000000296e45ec4-dmarc-request at list.improvediagnosis.org> wrote:

> I was thinking also of the accuracy in elderly patients with
> osteoarthritis, bent fingers, and soft skin versus hard thickened skin and
> also the differences with different fingers.
>
> Yes, alarms are a problem.
>
> Rob Bell, M.D.
> > On Jan 29, 2018, at 3:11 PM, Rory Jaffe <rjaffe at CHPSO.ORG> wrote:
> >
> > Interpretation is a big issue. Pulse oximetry is very insensitive to
> hypoventilation when a patient is on supplemental O2. Also tends to have
> lots of false alarms--the default limits are not very usable and ideally,
> people would use patient-specific alarm limits.
> >
> > -----Original Message-----
> > From: Grubenhoff, Joe [mailto:Joe.Grubenhoff at CHILDRENSCOLORADO.ORG]
> > Sent: Monday, January 29, 2018 8:55 AM
> > To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> > Subject: [No SPF Record] Re: [IMPROVEDX] Oximeters
> >
> > Pretty accurate in my experience - the problem may be in how this single
> value is interpreted in the context of the whole clinical picture:
> >
> >
> >
> > Effect of Oxygen Desaturations on Subsequent Medical Visits in Infants
> Discharged From the Emergency Department With Bronchiolitis.
> >
> > Principi T, Coates AL, Parkin PC, Stephens D, DaSilva Z, Schuh S.
> >
> > JAMA Pediatr. 2016 Jun 1;170(6):602-8. doi: 10.1001/jamapediatrics.2016.
> 0114.
> >
> >
> >
> > Effect of oximetry on hospitalization in bronchiolitis: a randomized
> clinical trial.
> >
> > Schuh S, Freedman S, Coates A, Allen U, Parkin PC, Stephens D, Ungar W,
> DaSilva Z, Willan AR.
> >
> > JAMA. 2014 Aug 20;312(7):712-8. doi: 10.1001/jama.2014.8637.
> >
> >
> >
> >
> >
> > ´╗┐On 1/29/18, 09:49, "Robert Bell" <0000000296e45ec4-dmarc-
> request at LIST.IMPROVEDIAGNOSIS.ORG> wrote:
> >
> >
> >
> >    How accurate are oximeters? Are the errors big enough to make wrong
> decisions?
> >
> >
> >
> >    Rob Bell, M. D.
> >
> >
> >
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