Hi all,
I’m currently on placement on an acute respiratory ward. This week, I think what has surprised me the most has been just how quickly patients desaturate with any kind of effort. A good example of this was a 75 yo lady I was seeing with an acute infective exacerbation of COPD complaining almost exclusively of SOB. Her O2 sats were to be maintained between 88 and 92% and O2 could be adjusted between 0-4L depending on what she required at the time. At rest her sats were maintained in this range on 0.5L O2. On exertion, the standard 85% was when she had to stop and rest.
When it was time to go for a walk, I turned to O2 up to 2L/min (which was the recommended amount) and off we went. We had probably walked about 20m before her sats dropped to 85% so I asked my pt to sit down and have a rest. She assured me that she wasn’t too breathless, felt fine and didn’t need a rest but with a little persuasion she did. While she was sitting, her sats stayed around the 84-85% range but then she started randomly telling me a story about her family. Just from the increased effort from talking, her sats dropped rather quickly to 78%. I turned her O2 up and tried to encourage her to stop talking which was quite difficult, so in the end I had to be rather blunt with her. It took a good 3-4 min for her sats to come back up again before we could try the walk back to her room.
I know we are told at uni how quickly sats can drop, but even so, I was still amazed at just how quickly it can happen and how the pts don’t even know anything is wrong. It really makes you wonder what their sats levels are when they’re at home during their everyday activities.
Tara
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2 comments:
Hey Tara
Yea i had a patient like that, a gentleman actually in hopsital for ostermyelitis, but with acute renal failure and subsequent pulmonary edema. He is on 6L oxygen via a hudson mask and on one day last week, when I was planning on taking him for a walk, when he was coughinp up come lovely pink sputum, his sats were around 84-86%. What alarmed me was that after taking his mask off for a minute to bring up some sputum, his sats dropped to 77%! They again went back up to 85% with the mask back on but wouldnt go any higher. So i noticifed my supervisor, who told the nurse co-ordinator and who then contacted the doctors. His oxygen was increased to 10L which slowly did the trick. So I definately agree that this kind of thing happens so quickly and constant monitoring is needed to ensure our patients are safe and that we dont just rely on subjective information.
Hi Tara, I absolutely identify with your observations. My patient at my previous placement had the same problems. He desaturated from 93-88% just by talking (even with 3L O2 via NPs) which was really surprising as i've never seen anyone that bad before. However, the interesting thing was that his SOB rating remained at a 2/10. This further confirms the non-relation between SOB and SpO2 i suppose- which is also something we learnt in uni but i never actually experienced till then.
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