Old-school assessments

When I first started this field, we didn’t have the luxury of a pulse oximeter in the field. The concept was hardly new, as it was being used frequently in emergency rooms and operating rooms.

Now, it has become the “sixth” vital sign, along with pulse rate, blood pressure, respirations, mental status, and blood glucose.

We used to actually assess the patient’s work of breathing, skin color, temp, and moisture, along with capillary refill time. Does anyone else remember “CRT is less than 2?” You know, squeezing the patient’s fingernail, or touching their forehead, and counting how long it took for color to return?

CRT, skin, and work of breathing can tell you a whole lot more about a patient’s status than a pulse-ox ever could. And don’t even get me started on using the pulse-ox to count a pulse.

I rarely use pulse oximetry to guide my application of oxygen. If I have a patient with a known history of emphysema, breathing 20 times a minute, with no distress, with clear breath sounds, and no accessory muscle usage, chances are that patient does not need a non-rebreather simply because “their O2 sat is 90.”

I am much more concerned with the end-tidal CO2 on the emphysema patient than I am with the pulse oximetry.

Using pulse oximetry can be valuable, but all too often, it is used in place of a good assessment, and that’s just plain lazy.


  1. Way back when I first started blogging, I had a long rant on Pulse Oximetry. I hit all of the points you did, but in a much longer manner.

    It’s completely over used and under understood. Last night we had a patient in failure, with rales to the apecies bilaterally. Pretty close to total respiratory failure. Want to guess her O2 saturation?

  2. Amen!

    Now can we please kill the concept of the Room Air Sat? If I put a patient on O2, it’s because he needs it. You wouldn’t discontinue any of my other treatments just to see what happened.

    Well, some nurses might. . .

    • I had a doctor who took a patient off of CPAP to see if it was really helping. Yeah, it was, put it back on moron. I’m not sure I actually called him a moron, but I did have a word or ten with his attending physician about the resident sleeping through respiratory illnesses that day in medical school.

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