Procedure 11 - Airway/Breathing: Pulse Oximetry

What clinical indication requires pulse oximetry?

All patients accepting or refusing transport by EMS.

What is the first step of pulse oximetry application?

Apply the probe to the patient's finger or any other digit as recommended by the device manufacturer.

What should be recorded on the PCR regarding initial pulse oximetry?

The time and initial saturation percent on room air (if possible).

What should be verified against the machine's pulse rate?

The actual pulse of the patient.

How should critical patients be monitored with pulse oximetry?

Continuously throughout EMS care.

How long should a patient be monitored for a one-time pulse oximetry reading?

A few minutes, as oxygen saturation measurements may vary.

When should oxygen saturation percent be documented?

Every time a full set of vital signs are recorded and in response to any therapy that corrects hypoxemia.

What is the normal pulse oximetry saturation range?

92 to 99%.

What should be suspected if pulse oximetry reads below 92%?

Respiratory compromise that may or may not be from a chronic condition (example: COPD).

How should pulse oximetry be used in patient evaluation?

As a tool for every patient evaluation; treat the patient, not just the data provided by the device.

Should the pulse oximeter reading ever be used to withhold oxygen from a patient in respiratory distress?

No, it should never be used to withhold oxygen when it is the standard of care to apply oxygen, such as with chest pain.

When is supplemental oxygen not required based on pulse oximetry?

If the oxyhemoglobin saturation is ≥92%.

What saturation range should be maintained if there are signs of ischemia, heart failure, dyspnea, or hypoxia?

Between 92 and 99%, depending on the patient's condition.

What circulatory factors may reduce pulse oximetry reliability?

Poor peripheral circulation (blood volume, hypotension, hypothermia).

What motion factor may reduce pulse oximetry reliability?

Excessive pulse oximeter sensor motion.

What cosmetic factor may reduce pulse oximetry reliability and how is it addressed?

Fingernail polish; it may be removed with an acetone pad or the sensor rotated 90 degrees.

What toxic exposure affects pulse oximetry accuracy?

Carbon monoxide bound to hemoglobin will provide inaccurate readings.

What rhythm factor may reduce pulse oximetry reliability?

Irregular heart rhythms that affect pulse quality/strength (atrial fibrillation, SVT, etc.).

What skin condition may reduce pulse oximetry reliability?

Jaundice.

What placement error may reduce pulse oximetry reliability?

Placing the blood pressure cuff on the same extremity as the pulse oximeter sensor.

What provider levels can perform pulse oximetry per CFD protocol?

EMT-A, EMT-B, and EMT-P.