walking o2 sat in asthma patients?

[12R34Y]

We routinely do an ambulatory o2 sat on patients who require nebs/steroids with asthma/copd exacerbations prior to discharge.

It's part of the protocol we have here and is entrenched in our culture. A few of our staff hate it and don't like the practice.

Anyone else out there care about an ambulatory O2 sat in a stable patient whose room air sat after treatment is okay?

Are others making dispos on this?

We frequently have the asthma/copd person come in and get their nebs, sometimes an hour of continuous albuterol, prednisone, etc....then after we obs them and they're looking great, room air sat okay, wheezing gone, peak flows improving etc...we get ambulatory sat of 89% and then they get admitted.

Any evidence to support this?

I understand the benefit of getting it, but just curious if others routinely do this in other ED's.

later

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[quideam]

We do it in our ED here also. I'm not sure what kind of evidence there is for it, but i've worked with at least a few attendings who definitely do walking O2 sats repeatedly.

 

[EM2BE]

They don't do it where I am..at least in the peds ED never saw it and I was there in high asthma time.

 

[12R34Y]

Agreed.

We never ever do that in the peds ER. Only in our adult ER. All we care about in kids is their room air sat after treatment/obs.

wonder what the difference is?


later

 

[roja]

Have never done that in Asthma/COPD pts. Time to start a lit search

 

[DrQuinn]

Weird. I walk them around, but not to check their sats but to make sure they cna tolerate a few laps 'round the good old fish bowl. If they are symtpomatic its not time to go home yet. They'll desat but I'll ask the nurse if they were symptomatic. Symptomatology is far more importnat to me than numbers.

Q

 

[12R34Y]

it just goes against my inner judgement and 'gut feeling' to send a guy home who walks to the bathroom and his sat goes to 83%. Although he says he feels fine, how can that be a good thing?

All, i'm saying is that i'd LOVE not to do it, but my staff likes it and it is the culture at my institution.

i'd just like to go with some ammo and am too lazy to lit search it.

any eager beavers?

later

 

[deleted65604]

I did a lit search and came up with nothing. If you pubmed "ambulatory pulse oximetry and asthma", you get 5 articles that don't mention the concept. Pulmonary medicine textbook on MDconsult doesn't mention it, and neither does Rosen's. I give up.

 

[leviathan]

it just goes against my inner judgement and 'gut feeling' to send a guy home who walks to the bathroom and his sat goes to 83%. Although he says he feels fine, how can that be a good thing?

All, i'm saying is that i'd LOVE not to do it, but my staff likes it and it is the culture at my institution.

i'd just like to go with some ammo and am too lazy to lit search it.

any eager beavers?

later

How accurate are the oximeters when someone is walking around and moving their arms/hands/fingers? I find that they sometimes drop low but once you steady their hands it will come back up to a normal reading.

 

[12R34Y]

okay, now my brain is churning..........

so, what about the pneumonias?, chf? etc...do you guys ever get walking o2 sats on these guys as a discharge criteria?

 

[TakayaSue]

We definitely have some attendings that do this on adult asthmatics. Personally, I think it makes sense to "road test" any potential disposition/therapy to limit bouncebacks. If I get somebody with a painful complaint, who I plan to D/C on PO pain meds, I often try to give them a dose in the ED, to make sure it's covering them -- same basic concept. If a patient isn't bed-bound, wheelchair-bound, etc. and plans on walking at home, you want to be sure their lungs can accommodate their planned/acustomed lifestyle. Quinn is probably right that subjective tolerance is more important than peripheral O2 sats, though sats are nice b/c the nurses can document them.

In med school, we only used this to diagnose potential PCP in HIV patients, and to evaluate COPDers for home O2, but we are using it for adult asthmatics here in residency...