Date of Issue: 07/01/2019 - Indian Mills Vol. Fire Co.



SUBJECT:Pulse Oximetry MonitoringPURPOSE:To clearly establish the Department’s position on the clinical care and treatment of patients presenting with symptoms of respiratory insufficiency.SCOPE: This Operating Guideline shall be applicable to all personnel; paid and volunteer, operating as an agent of Shamong EMSRESPONSIBILITY:All Department Officers will ensure overall compliance with this operating guideline. The primary responsibility of the emergency care and treatment of medical and trauma patients falls under Emergency Medical Technicians, paid and volunteer, operating as an agent of Shamong EMSPROCEDURE: All emergency medical technicians shall review and fully understand this standard operating guideline and the use of all patient monitoring devices prior to use. Electronic patient vital sign monitors may be utilized as an adjunct to the ongoing patient assessment. Providers will not utilize these devices as a primary assessment tool, but rather as a confirmation device upon reassessment. Clinical guidelines (established in parameters below) will dictate the use of each device as well as its interpretation. Pulse Oximetry is to be used as an assessment adjunct, never as a primary assessment tool. Pulse Oximetry should be attached to the patient after manual baseline vital signs are established. Oxygen administration should NOT be delayed while awaiting applications and results of Pulse Oximetry. PULSE OXIMETRY PARAMETERS: The percentage of oxygen in a patient’s blood can indicate the degree of respiratory distress and hypoxia a patient is experiencing. Assessment percentages of oxygen levels for patients are as follows: A pulse Oximetry reading of 95% - 99% is considered normal. A pulse Oximetry reading of 91% - 94% is considered mild hypoxia. A pulse Oximetry reading of 86% - 90% is considered moderate hypoxic Requires close monitoring of the patient, patient's vital signs and; potentially, ALS intervention.A pulse Oximetry reading of ≤85% is considered severe hypoxiaRequires 100% oxygenation and ventilation along with ALS intervention. Note: Oxygen administration should be based on a patient’s signs and symptoms, and the patient assessment findings. (Pulse Ox readings are never to be used as the determining factor for the application of oxygen). For patients under the age of five years old, a pediatric oximetry probe shall be used. For patients greater than five years old, the regular oximetry probe should be sufficient.If a pediatric oximetry probe is unavailable, then the pulse ox is not to be utilized.B) Apply the oximetry probe to the finger over the nail bed, and have the patient breath normally, not having them take deep breaths. C) Read the saturation percentage and pulse rate, verify that the pulse rate shown concurs with a palpated radial pulse. D) Document the saturation percentage read, if the palpated pulse concurs, and the time.E) If the patient is in cardiac arrest the pulse ox should not be applied until the patient has return of spontaneous circulation (R.O.S.C.). Note: At no time should a pulse oximetry device and the AED be applied to a patient at the same time. Successful defibrillation of the patient with the pulse oximeter device attached will cause permanent and catastrophic damage to the oximeter device.POTENTIAL FALSE READING SITUATIONS:A) Nail polish, dyes, or false nails on a patient’s nail bed. B) Exposure to and inhalation of carbon monoxide (i.e. smoke inhalation). C) Oximetry probe is not placed over the finger properly. D) Patient is hypothermic of even a few degrees. E) Patient is hypotensive. F) Patient is taking drugs that have vasoactive actions. G) Patient has a vascular disease. H) Strong ambient light such as direct sunlight. I) Medical diagnostic dyes the patient has consumed within the last 24 hours. J) Oximetry probe placed over blood blister on patient’s nail bed. K) Oximetry probe placed on same extremity that blood pressure cuff is on. EnforcementFailed compliance with the policy and procedures outlined in this document may result in the employee’s entry to the department’s progressive counseling and discipline process. ................
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