pulse oximeter

ROBERT M BELL rmsbell200 at YAHOO.COM
Thu May 17 03:43:28 UTC 2018


Thanks.

Yes, broken in every direction.

What to do?

Rob


> On May 16, 2018, at 6:55 PM, Behnke, Lyn <lbehnke at umflint.edu> wrote:
> 
> Blood pressure measurement is a terrible problem.  Weight measurement.  All those “basic” science issues are a challenge.  I do think, however, if we waited for the nation to adopt complete hospital error transparency we will all be dead and long gone.  Kaiser is doing an interesting program looking at billing issues and it is reported out on NPR.  That structure seems a little more benign, gets the messaging out and supports their research.
> 
> It is hard for me as a PCP who has moved to academia to listen to these stories day after day after day.  I admit, I tried going back into practice to do some simple things like medicare physicals, primary care in an Assisted Living situation and sports physicals.  I couldn’t be successful because I didn’t have access to the information that I needed to make diagnoses.  So, I gave that up and am doing acupuncture where I only have to depend on the patient.
> 
> The system is so broke.
> 
> 
> From: ROBERT M BELL <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>
> Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, ROBERT M BELL <rmsbell200 at YAHOO.COM>
> Date: Wednesday, May 16, 2018 at 5:51 PM
> To: <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> Subject: Re: [IMPROVEDX] pulse oximeter
> 
> Thanks Ed,
> 
> There is the suggestion with your experience that it could affect management if not recognized.
> 
> If so, could SIDM focus on the tests we use for accuracy while waiting for the nation to adopt complete hospital error transparency, handle any negative image problems, and deal with litigation issues. And I think that there are even answers there.
> 
> I realize that as retired physician I am less conflicted and can speak a little more strongly. Which brings up the question of how to deal with this conflict for the sake of our patients?
> 
> Not easy,
> 
> Rob
> On May 16, 2018, at 12:25 PM, Ed Hoffer <ehoffer at gmail.com<mailto:ehoffer at gmail.com>> wrote:
> 
> In my office it was obvious - either no reading at all or obviously false (O2 sat of 80 in patient pink and in distress). I found simplest was to have them sit on one hand for few minutes while I examined other parts. Rarely needed hot water.
> Ed
> Edward Hoffer MD, FACC
> Sent from my iPhone
> 
> On May 16, 2018, at 1:06 PM, ROBERT M BELL <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG<mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>> wrote:
> Thanks. How many HCPs do you think know that?
> 
> Is there a formal recommendation to warm the hands/limb if cool to get an accurate reading?
> 
> What is the average error if not warmed and is that, in some patients, big enough to make the wrong decision in management?
> 
> Rob
> On May 15, 2018, at 6:39 PM, Behnke, Lyn <lbehnke at UMFLINT.EDU<mailto:lbehnke at UMFLINT.EDU>> wrote:
> 
> Yes, Dr. Bell, the temperature of the limb affects the pulse oximeter reading.  Cold hands, lower O2 saturation.  That has been true in my practice, however, there is also literature to support warming up the hands before using the oximeter.  Other solutions:  Ear clips (expensice) and adhesive trips that go on the forehead held by headbands.
> 
> With warmest regards,
> 
> Dr. Lyn Behnke, DNP, FNPBC, CAFCI, FAAIM, CHFN
> Assistant Professor of Nursing
> School of Nursing
> University of Michigan - Flint
> 2180 William S. White Building
> 303 E. Kearsley Street
> Flint, Michigan 48502-1950
> 
> Office phone (810) 762-3451
> Fax (810) 766-1950
> 
> lbehnke at umflint.edu<mailto:lbehnke at umflint.edu>
> 
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine




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