Can prehospital personnel detect hypoxemia without the aid of pulse oximeters?

doi:10.1016/S0735-6757(96)90012-1

The American Journal of Emergency Medicine

Volume 14, Issue 1, January 1996, Pages 43-44

https://doi.org/10.1016/S0735-6757(96)90012-1 Get rights and content

Abstract

Although pulse oximeters have been proven accurate in the prehospital environment, they have not been proven to be necessary. This study was undertaken to determine if emergency medical services (EMS) providers can identify hypoxemia without pulse oximetry. An oximeter was placed at the ambulance entrance to the emergency department (ED), and EMS personnel obtained saturation levels on all patients on arrival. Hypoxemia was defined as a saturation level of 95% or less. The hypoxemia was classified as “recognized” if the patient received aggressive intervention and “unrecognized” if the patient did not. One hundred eighty patients were enrolled in the study; 30 had a saturation level of 95% or less. Twenty-seven (90%) of those patients had “unrecognized” hypoxemia. Twenty-three (85.2%) of the 27 patients with “unrecognized” hypoxemia did not complain of respiratory distress. Thus, there are patients whose hypoxemia is unrecognized by EMS providers, and this occurs most frequently in patients who do not complain of respiratory distress.

References (11)

TJ McGuire et al.
Evaluation of a pulse oximeter in the prehospital setting
Ann Emerg Med
(1988)
J Morales
Pulse oximetry in the ED
Am J Emerg Med
(1990)
JP Galdun et al.
Pulse oximetry in the emergency department
Am J Emerg Med
(1989)
HB Kram
Noninvasive tissue oxygenation monitoring in surgical and critical care medicine
Surg Clin North Am
(1985)
L Short et al.
A comparison of pulse oximeters during helicopter flight
J Emerg Med
(1989)

There are more references available in the full text version of this article.

Cited by (31)

Predictors of oxygen saturation ≤95% in a cross-sectional population based survey
2012, Respiratory Medicine
Citation Excerpt :
One study applied pulse oximetry in the selection of patients for spirometry in order to diagnose chronic obstructive pulmonary disease (COPD), but was not found useful.1 There is no clear cut-off point for abnormal oxygen saturation, but SpO2 ≤95% is used in some studies.2 Resting SpO2 ≤95% has been found to predict oxygen desaturation during sleep3 and during exercise4 in COPD patients.
Pulse oximetry has become an important tool in evaluating, and monitoring pulmonary diseases, but the knowledge about arterial oxygen saturation (SpO₂) values in a general population is limited. The aim of this study was to describe the distribution of low pulse oximetry values in a general adult population and their association with certain predictors.
A cross-sectional population based survey was performed in Tromsø, Norway, in 2007–2008. Valid SpO₂ and pre-bronchodilator spirometry was recorded in 6317 participants aged 38–87 years (57% women). Resting SpO₂ ≤95% was defined as an abnormal value. Predictors of SpO₂ ≤95% with p < 0.05 were entered into a binary multivariable logistic regression.
The prevalence of SpO₂ ≤95% was 6.3%. The strongest predictors in the logistic regression were increased body mass index (BMI) (OR of BMI ≥35 = 6.2, CI(4.2, 9.2)), and reduced forced expiratory volume in 1 s (FEV₁) % predicted (OR of FEV1% predicted <50 = 4.1, CI(2.5, 6.7)), followed by increased age, male gender, and smoking (p < 0.001). Other significant predictors were elevated C-reactive protein (CRP) (p < 0.005), former smoking, breathlessness and elevated hemoglobin (p < 0.01).
Airflow limitation and other known signs of pulmonary diseases were, as expected, strongly associated with decreased oxygen saturation. Obesity was also a strong predictor of low SpO₂, and should be included among possible explanations when low SpO₂ values are encountered.
Respiratory distress and respiratory failure
2008, Pediatric Emergency Medicine
Monitoring in critically ill children
2008, Pediatric Emergency Medicine
Respiratory Distress and Respiratory Failure
2007, Pediatric Emergency Medicine
Monitoring in Critically Ill Children
2007, Pediatric Emergency Medicine
Pulse oximetry in clinical forensic practice
2006, Journal of Clinical Forensic Medicine
The potential role of a hand held battery operated digital pulse oximeter was investigated on 270 consecutive patients seen by one forensic medical examiner. An oxygen saturation reading on air was obtained on 236 patients (87%). Of the patients in whom the pulse oximeter could not provide a reading, the principal reason for being unable to record a value was lack of patient cooperation (26 of the 34 patients). Of the 236 oxygen saturations recorded, 234 were 95% or higher. The two patients with lower readings (83% and 93%) required assessment and treatment at hospital: one for an opioid overdose, the other for pneumonia. The modern generation of hand held pulse oximeters can provide very useful information in a challenging environment and should occupy a definite corner of the forensic medical examiner’s medical bag.

View all citing articles on Scopus

View full text

Brief reportCan prehospital personnel detect hypoxemia without the aid of pulse oximeters?

Abstract

Ann Emerg Med

Am J Emerg Med

Am J Emerg Med

Surg Clin North Am

J Emerg Med

Brief report
Can prehospital personnel detect hypoxemia without the aid of pulse oximeters?