low o2 sats after ORIF?

  1. What the heck would cause low O2 sats after a ORIF of hip? Spinal ana, low hgb, tx with 1 unit PRBC, no other problems? No hx of lung dx, infections. Any ideas?
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  2. 32 Comments

  3. by   veegeern
    Pain or sedation resulting in shallow breathing or slowed respiration rate? I've seen it with other procedures.
  4. by   TexasPediRN
    Anesthesia or meds? Thats my best guess...
  5. by   reesern63
    Low hgb could be giving you the low sat reading. Decreased mobility causing decreased pulm. function. How old is the pt? How far into the post-op period? Lots and lots of reasons why this can happen.
  6. by   crissrn27
    I voted for the low hgb, but the nurse I was talking to said no way. Pt is 87y/o, 36 hours post-op. Taking DCN-100 for pain and had spinal ana. I do babies, we know what causes there low sats! lol, thanks for the responses guys!
  7. by   meownsmile
    Usually even with spinal, they have iv sedation and it takes a while to metabolize. Decreased depth of respirations will cause it. The patient coughs and deep breaths, uses the spirometer a few times and it comes back up usually. It may take 12-24 hrs for it to stay up.
  8. by   TazziRN
    Sedation, pain, pain meds. I had a spinal for my c/s with Duramorph and had trouble keeping my sats up because I kept falling asleep and my resps got shallow.
  9. by   Roy Fokker
    87 yr old post hip fx and tx?

    I vote shallow breathing r/to low mobility.
    That and the ana (but 36 hours post op might be pushing it. I would check kidney function and see how they're urinating wastes...)

    The patient coughs and deep breaths, uses the spirometer a few times and it comes back up usually. It may take 12-24 hrs for it to stay up.
    Bingo!
  10. by   RedCell
    Quote from crissrn27
    What the heck would cause low O2 sats after a ORIF of hip? Spinal ana, low hgb, tx with 1 unit PRBC, no other problems? No hx of lung dx, infections. Any ideas?

    Unless the dude has a high spinal, I would not exclude a PE. Fat embolisms are fairly common in suckers who have had their hips replaced/fixed etc... Might want to see about getting a chest CT or V/Q scan.
  11. by   Spidey's mom
    Quote from meownsmile
    Usually even with spinal, they have iv sedation and it takes a while to metabolize. Decreased depth of respirations will cause it. The patient coughs and deep breaths, uses the spirometer a few times and it comes back up usually. It may take 12-24 hrs for it to stay up.
    Yup - very important to do teaching prior to surgery in how to use the incentive spirometer. And to start that asap after surgery. Shallow breathing due to anesthesia is a risk for pneumonia . . . use that incentive spirometer!

    steph
  12. by   P_RN
    Pickwickian? Big Belly and having to lie flat?

    Did you account for your patients age in the offset before determining the O2 sats?
  13. by   RedERRN
    Sounds like its time for a d-dimer and spiral CT of the chest to rule out PE (fat embolism). This is VERY common after ORIF of long bone Fxs.
  14. by   purple1953reading
    I recently had a TKR revision, and had to wear a pulse ox all night, and the thing would not recognize my shallow breathing pattern, which is normal for me. It went off all night long, and needless to say, I got very little sleep,as it was even worse when I tried to sleep. The protocol at that hospital was for continuous pulse ox with any PCA. I have had this before post op from a tubal, by scope. Again,it just didn't recognize the shallowness of my breathing pattern. Just a guess a part from others already suggested.

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