Oximeters

Robert Bell rmsbell200 at YAHOO.COM
Wed Jan 31 04:21:57 UTC 2018


 Thanks Tom,
That is something to consider. How many HCPs know about that? 
What about, Ipsilateral sphygmomanometer cuff - oximeter reading error!!
And do not get me started on the frequency with which blood pressures are taken with the wrong sphygmomanometer cuff size, and through clothing (some times thick). 
I have in my postings to the list here always been interested in the level of error in the things we do to help us with diagnoses. I strongly believe that we need, to not only be improving our diagnostic abilities, but also work to improve the errors of support tools at the same time. Both need to be worked upon to get to our goal of significant reductions in diagnostic error. That could be done with partnering with another society or societies, more dedicated to standard errors, with time related goals to help get there soon.
Robert Bell
    On Tuesday, January 30, 2018, 2:57:56 PM MST, Tom Benzoni <benzonit at GMAIL.COM> wrote:  
 
 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@ 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.
>
>
>
>    Sent from my iPad
>
>    To unsubscribe from the IMPROVEDX:
>
>    mail to:IMPROVEDX-SIGNOFF-REQUEST@ LIST.IMPROVEDIAGNOSIS.ORG
>
>    or click the following link: IMPROVEDX at LIST. IMPROVEDIAGNOSIS.ORG
>
>
>
>    Address messages to: IMPROVEDX at LIST. IMPROVEDIAGNOSIS.ORG
>
>
>
>    For additional information and subscription commands, visit:
>
>    https://urldefense.proofpoint. com/v2/url?u=http-3A__www. lsoft.com_resources_faq.asp- 234A&d=DwIGaQ&c=hx0HUg_nG- xRkKlwWZeJFCbvzzw0Ym5DwdL_ 1FKbReI&r= ykcs2wU25yxj5BckI49bSg&m= QIkoLzICpYYYnJV71LxRMewHHWap0B 4fISMAF5CYMLo&s= XGRvfk3p8CdSeW0N_08vlgmlnHAem_ eHK86cKpflQv8&e=
>
>
>
>    https://urldefense.proofpoint. com/v2/url?u=http-3A__LIST. IMPROVEDIAGNOSIS.ORG_&d= DwIGaQ&c=hx0HUg_nG- xRkKlwWZeJFCbvzzw0Ym5DwdL_ 1FKbReI&r= ykcs2wU25yxj5BckI49bSg&m= QIkoLzICpYYYnJV71LxRMewHHWap0B 4fISMAF5CYMLo&s= V7MGXsYV3B04MvAMnWiTC7VuZ993fU aj5SeNz-3c7YQ&e= (with your password)
>
>
>
>    Visit the searchable archives or adjust your subscription at:
>
>    https://urldefense.proofpoint. com/v2/url?u=http-3A__list. improvediagnosis.org_scripts_ wa-2DIMPDIAG.exe-3FINDEX&d= DwIGaQ&c=hx0HUg_nG- xRkKlwWZeJFCbvzzw0Ym5DwdL_ 1FKbReI&r= ykcs2wU25yxj5BckI49bSg&m= QIkoLzICpYYYnJV71LxRMewHHWap0B 4fISMAF5CYMLo&s= rwIjA5J9u4OIzassBupn3eZKTnWOXP fS8FdmLjcnC-I&e=
>
>
>
>    Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine
>
>
>
>    To unsubscribe from the IMPROVEDX list, click the following link:<br>
>
>    <a href="https://urldefense. proofpoint.com/v2/url?u=http- 3A__list.improvediagnosis.org_ scripts_wa-2DIMPDIAG.exe- 3FSUBED1-3DIMPROVEDX-26A-3D1& d=DwIGaQ&c=hx0HUg_nG- xRkKlwWZeJFCbvzzw0Ym5DwdL_ 1FKbReI&r= ykcs2wU25yxj5BckI49bSg&m= QIkoLzICpYYYnJV71LxRMewHHWap0B 4fISMAF5CYMLo&s= lyvKwnUZgRPBhfNCIu9JFtzglcSuGj DtA4pR1Q6eZFA&e=" target="_blank">https:// urldefense.proofpoint.com/v2/ url?u=http-3A__list. improvediagnosis.org_scripts_ wa-2DIMPDIAG.exe-3FSUBED1- 3DIMPROVEDX-26A-3D1&d=DwIGaQ& c=hx0HUg_nG- xRkKlwWZeJFCbvzzw0Ym5DwdL_ 1FKbReI&r= ykcs2wU25yxj5BckI49bSg&m= QIkoLzICpYYYnJV71LxRMewHHWap0B 4fISMAF5CYMLo&s= lyvKwnUZgRPBhfNCIu9JFtzglcSuGj DtA4pR1Q6eZFA&e=</a>
>
>    </p>
>
>
>
>
>
> ***************
>
> CONFIDENTIALITY NOTICE:  This e-mail, including any attachments, is for the sole use of the intended recipient and may contain confidential and privileged information.  If you are not an intended recipient, or the person responsible for delivering this message to an intended recipient, you are hereby notified that reading, copying, using or distributing this message is prohibited. If you are not an intended recipient, please contact the sender by reply email and destroy all copies of the original message from your computer system.
>
> ***************
>
>
>
>
> To unsubscribe from the IMPROVEDX:
>
> mail to:IMPROVEDX-SIGNOFF-REQUEST@ LIST.IMPROVEDIAGNOSIS.ORG
>
> or click the following link: IMPROVEDX at LIST. IMPROVEDIAGNOSIS.ORG
>
>
>
> Address messages to: IMPROVEDX at LIST. IMPROVEDIAGNOSIS.ORG
>
>
>
> For additional information and subscription commands, visit:
>
> https://urldefense.proofpoint. com/v2/url?u=http-3A__www. lsoft.com_resources_faq.asp- 234A&d=DwIGaQ&c=hx0HUg_nG- xRkKlwWZeJFCbvzzw0Ym5DwdL_ 1FKbReI&r= ykcs2wU25yxj5BckI49bSg&m= QIkoLzICpYYYnJV71LxRMewHHWap0B 4fISMAF5CYMLo&s= XGRvfk3p8CdSeW0N_08vlgmlnHAem_ eHK86cKpflQv8&e=
>
>
>
> https://urldefense.proofpoint. com/v2/url?u=http-3A__LIST. IMPROVEDIAGNOSIS.ORG_&d= DwIGaQ&c=hx0HUg_nG- xRkKlwWZeJFCbvzzw0Ym5DwdL_ 1FKbReI&r= ykcs2wU25yxj5BckI49bSg&m= QIkoLzICpYYYnJV71LxRMewHHWap0B 4fISMAF5CYMLo&s= V7MGXsYV3B04MvAMnWiTC7VuZ993fU aj5SeNz-3c7YQ&e= (with your password)
>
>
>
> Visit the searchable archives or adjust your subscription at:
>
> https://urldefense.proofpoint. com/v2/url?u=http-3A__list. improvediagnosis.org_scripts_ wa-2DIMPDIAG.exe-3FINDEX&d= DwIGaQ&c=hx0HUg_nG- xRkKlwWZeJFCbvzzw0Ym5DwdL_ 1FKbReI&r= ykcs2wU25yxj5BckI49bSg&m= QIkoLzICpYYYnJV71LxRMewHHWap0B 4fISMAF5CYMLo&s= rwIjA5J9u4OIzassBupn3eZKTnWOXP fS8FdmLjcnC-I&e=
>
>
>
> Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine
>
>
>
> To unsubscribe from the IMPROVEDX list, click the following link:<br>
>
> <a href="https://urldefense. proofpoint.com/v2/url?u=http- 3A__list.improvediagnosis.org_ scripts_wa-2DIMPDIAG.exe- 3FSUBED1-3DIMPROVEDX-26A-3D1& d=DwIGaQ&c=hx0HUg_nG- xRkKlwWZeJFCbvzzw0Ym5DwdL_ 1FKbReI&r= ykcs2wU25yxj5BckI49bSg&m= QIkoLzICpYYYnJV71LxRMewHHWap0B 4fISMAF5CYMLo&s= lyvKwnUZgRPBhfNCIu9JFtzglcSuGj DtA4pR1Q6eZFA&e=" target="_blank">https:// urldefense.proofpoint.com/v2/ url?u=http-3A__list. improvediagnosis.org_scripts_ wa-2DIMPDIAG.exe-3FSUBED1- 3DIMPROVEDX-26A-3D1&d=DwIGaQ& c=hx0HUg_nG- xRkKlwWZeJFCbvzzw0Ym5DwdL_ 1FKbReI&r= ykcs2wU25yxj5BckI49bSg&m= QIkoLzICpYYYnJV71LxRMewHHWap0B 4fISMAF5CYMLo&s= lyvKwnUZgRPBhfNCIu9JFtzglcSuGj DtA4pR1Q6eZFA&e=</a>
>
> </p>
>
>
> To unsubscribe from the IMPROVEDX:
> mail to:IMPROVEDX-SIGNOFF-REQUEST@ LIST.IMPROVEDIAGNOSIS.ORG
> or click the following link: IMPROVEDX at LIST. IMPROVEDIAGNOSIS.ORG
>
> Address messages to: IMPROVEDX at LIST. IMPROVEDIAGNOSIS.ORG
>
> For additional information and subscription commands, visit:
> http://www.lsoft.com/ resources/faq.asp#4A
>
> http://LIST.IMPROVEDIAGNOSIS. ORG/ (with your password)
>
> Visit the searchable archives or adjust your subscription at:
> http://list.improvediagnosis. org/scripts/wa-IMPDIAG.exe? INDEX
>
> Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine
>
> To unsubscribe from the IMPROVEDX list, click the following link:<br>
> <a href="http://list. improvediagnosis.org/scripts/ wa-IMPDIAG.exe?SUBED1= IMPROVEDX&A=1" target="_blank">http://list. improvediagnosis.org/scripts/ wa-IMPDIAG.exe?SUBED1= IMPROVEDX&A=1</a>
> </p>

To unsubscribe from the IMPROVEDX:
mail to:IMPROVEDX-SIGNOFF-REQUEST@ LIST.IMPROVEDIAGNOSIS.ORG
or click the following link: IMPROVEDX at LIST. IMPROVEDIAGNOSIS.ORG

Address messages to: IMPROVEDX at LIST. IMPROVEDIAGNOSIS.ORG

For additional information and subscription commands, visit:
http://www.lsoft.com/ resources/faq.asp#4A

http://LIST.IMPROVEDIAGNOSIS. ORG/ (with your password)

Visit the searchable archives or adjust your subscription at:
http://list.improvediagnosis. org/scripts/wa-IMPDIAG.exe? INDEX

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

To unsubscribe from the IMPROVEDX list, click the following link:<br>
<a href="http://list. improvediagnosis.org/scripts/ wa-IMPDIAG.exe?SUBED1= IMPROVEDX&A=1" target="_blank">http://list. improvediagnosis.org/scripts/ wa-IMPDIAG.exe?SUBED1= IMPROVEDX&A=1</a>
</p>





To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1 or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/  






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

HTML Version:
URL: <../attachments/20180131/ee4e8607/attachment.html>


More information about the Test mailing list