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Background

Hemoglobin
Gas Exchange and Respiration
HEMOGLOBIN
Hemoglobin
(abbreviated Hb) is the
iron-containing
oxygen-transport
metalloprotein in the
red blood cells of
vertebrates.
Hemoglobin transports
oxygen from the lungs
to the rest of the body,
where it releases the
oxygen for cell use.
HEMOGLOBIN (continue)
Gas exchange and
respiration
Gas exchange and
respiration
What is a Pulse
Oximeter?
A Pulse Oximeter is a device used to perform the
diagnostic procedure for determining the:

Percentage of hemoglobin (Hb) that is


saturated with oxygen
The oxygen saturation (SpO2) is a measure of
how much oxygen the blood is carrying as a
percentage of the maximum it could carry and is
sometimes referred to colloquially as the "sats"
reading
The heart rate
The heart rate refers to the number of times that
the heart contracts in a period of one minute
TYPES OF OXIMETERS
Designs:
Pulse Oximeter as part of an anesthetic
machine

A portable desktop unit

A finger/mobile pulse Oximeter


Pulse Oximeter as part of an
anesthetic machine
Pulse Oximeters
(continue)
Desktop Finger/mobile
What does a Pulse Oximeter
tell you?
A Pulse Oximeter can detect hypoxia (too little

oxygen to fulfill the needs of the brain and body)

before a patient shows signs of becoming cyanotic

(bluish discoloration of the skin and mucous

membranes due to not enough oxygen in the

blood).
Pulse Oximeters may be used
in patients:
Undergoing surgical Undergoing surgical
procedure under general procedure under conscious
anesthesia sedation
Pulse Oximeters may be used
in patients:
Emergency situations
like loss of
consciousness, trauma
etc.
After surgery during
the recovery phase

Monitoring the blood


oxygen saturation in
various aviation
situations
Sport applications –
e.g. mountaineering
Pulse Oximeters may be used
in patients:
 In the ICU, Pulse Oximetry is used
extensively on mechanically
ventilated patients, as it can
frequently detect problems with
oxygenation before they are noticed
clinically, as well as a valuable guide
for weaning patients off ventilation
and helping to assess the adequacy of
a patient's oxygen therapy.
 This continuing assessment process
has been instrumental in the
introduction of Pulse Oximeter usage
within the community and homecare
environment of patients suffering from
a variety of heart and lung diseases
and conditions
 Pulse Oximeters are routinely used in
certain hospital wards and in casualty
departments for immediate
assessment of patients
Pulse Oximeter
reading may not be accurate:
Reduced peripheral
pulsatile blood flow
Venous congestion
(partial obstruction of
the veins) of an arm or
leg
Bright overhead lights,
such as in an operating
theatre
Shivering or
significant, repeated
movement of the
sensor
Pulse Oximeter
reading may not be accurate:
Pulse oximetry
struggles to distinguish
between different
forms of hemoglobin,
such as carboxy-
hemoglobin
(hemoglobin combined
with carbon monoxide)
Nail varnish may cause
falsely low readings
with most pulse
Oximeters, especially
those colored blue or
black
The following won’t affect
the Pulse Oximeter reading:
Anemia Jaundice
But what is a "normal"
reading?
Firstly, we would ask "normal for whom"?

A fit, healthy person should have an oxygen


saturation level between 95% & 99%. Results
lower than this, and especially below 90%
may be caused by problems including lung
diseases, such as COPD, breathing difficulties,
cigarette smoking or circulatory problems
such as excessive bleeding or blood vessel
problems.
How does a Pulse
Oximeter Work?
The measurements are obtained
by simply shining two
By measuring how much light has been
absorbed by the oxygen in the blood, an
wavelengths of light (1 is a visible oxygen saturation or “sats” reading is
established and displayed as a
red beam, the other an invisible percentage of the maximum amount of
infrared beam) at e.g. the oxygen the blood could carry.
fingertip.
Q1 If a patient’s saturation
is unacceptably low, what
are your immediate actions?
Check
Airways,
Breathing
and
Circulation
(ABC)
Q1 If a patient’s saturation
is unacceptably low, what
are your immediate actions?
Check
Airways,
Breathing and
Circulation
(ABC)
Q2 An elderly patient is admitted with
pneumonia and has a pulse oximetry reading
of 75% breathing air. With oxygen 6L per
min, saturation improves to 85%. What are
the implications of this oximetry reading?
Q2 An elderly patient is admitted with
pneumonia and has a pulse oximetry reading
of 75% breathing air. With oxygen 6L per
min, saturation improves to 85%. What are
the implications of this oximetry reading?

The patient was


severely hypoxic
(Lack of Oxygen)

Increase
oxygen flow
Q3 What happens to the pulse
Oximeter reading of a patient
immediately after a cardiac arrest?

The pulse would


be lost (causing
the alarm to
sound) and the
saturations will
decrease
Q3 What happens to the pulse
Oximeter reading of a patient
immediately after a cardiac arrest?
The pulse would
be lost (causing
the alarm to
sound) and the
saturations will
decrease
Q4 What happens to the Pulse
Oximeter reading of a patient
immediately after a respiratory
arrest?
The
saturations
decrease until
cardiac arrest
occurs
Q4 What happens to the Pulse
Oximeter reading of a patient
immediately after a respiratory
arrest?
The
saturations
decrease until
cardiac arrest
occurs
In conclusion…
Pulse Oximetry is a useful modality for
assessing a patient’s pulse rate and
Hemoglobin Oxygen saturation in a number of
routine and emergency medical situations
The clinician should be aware of the
limitations of Pulse Oximetry and the various
factors that may produce a falsely low or high
reading
Always keep the basics principles of medicine
in mind, and keep a high level of suspicion -
especially when the figures don’t make sense!
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