The lowest O2 saturation I've ever seen - page 2

I recently cared for a patient with severe ARDS. She was deteriorating rapidly and was placed on a rotoprone bed (prone rotation therapy). High PEEP and/ or APRV were not suitable for her as she... Read More

  1. by   burnrn85
    Quote from SaraBart
    I recently cared for a patient with severe ARDS. She was deteriorating rapidly and was placed on a rotoprone bed (prone rotation therapy). High PEEP and/ or APRV were not suitable for her as she already had a large amount of subcutaneous emphysema and was at extremely high risk for a tension pneumothorax. The patient had to be frequently bagged and once proned we could not flip her back supine or she would code.

    Over the course of about 36 hours the patients O2 sats dropped steadily even with the prone therapy. She favored laying on her right side (good lung down) for her best sat in the 60s. She quickly desatted to the 20s when flat prone and came up to the 40s when laying on her left side.

    Now slowly her levels dropped lower and although proning was futile the family was not ready to let go, she was young and it was very sad. Ultimately I ended up seeing her O2 sat drop as low as 3% while rotating prone. There were 3 stars of accuracy the whole time, a great waveform, pulse correlated exactly with the HR and her extremities were warm and pink. The MD told me an O2 sat is not linear at this low of a level but I'm not sure what he meant. Yes, the oxyhemoglobin dissociation curve is not linear but does that mean her sat was not accurate? It would happen time and time again to the single digits, teens and 20s for lengthy periods of time until she ultimately went into the inevitable PEA. (She was a DNR at that point.)

    I've never seen anything like it and would love some insight! Thanks.
    How were her extremities warm and pink with such a low oxygenation?
  2. by   umcRN
    Quote from burnrn85
    How were her extremities warm and pink with such a low oxygenation?
    Yeah I was wondering that...my kids might tolerate a sat of 50 fine but they sure are blue...I actually had a "little boy blue" today as I called him. Comfortably satting low to mid 50's on 8L of high flow but there was no way he was going to tolerate a non-rebreather or bipap and since he was in no resp distress why bother? Kiddo looked like he'd eaten a blue popsicle and hands feet and body were blue blue blue.

    Sometimes when we can't get sats on the extremities we'll wrap the probe on an earlobe...or penis if one is available! If you can't get a sat in the diaper though you're not likely to get one anywhere else...
  3. by   Penelope_Pitstop
    Quote from umcRN
    Sometimes when we can't get sats on the extremities we'll wrap the probe on an earlobe...or penis if one is available! If you can't get a sat in the diaper though you're not likely to get one anywhere else...
    In adults, I'll use the ear lobe as well. (Not one of the wrap probes, though). For reasons I don't think I need to explain, we don't use our patients' penises. But I have used a nose!

    And I must say I imagined you asking around, "does anyone have a penis available?"
  4. by   umcRN
    Quote from DeLanaHarvickWannabe
    In adults, I'll use the ear lobe as well. (Not one of the wrap probes, though). For reasons I don't think I need to explain, we don't use our patients' penises. But I have used a nose!

    And I must say I imagined you asking around, "does anyone have a penis available?"
    Haha yes probably not as acceptable in the adult world! Our babes don't notice and if they're that sick they're probably pretty sedated (we don't do that to the walkie-talkie satting 50 two year olds!)
  5. by   katierobin23
    I work with babies, so it's different, but there's one in my unit now who occasionally still has a 'Mac attack' and sats single digits. She's always been really sensitive and would go from 99% to 9% in a heartbeat. I'm hoping she doesn't have residual damage from all these spells, she always recovers beautifully, but you never know.
  6. by   umcRN
    Quote from katierobin23
    I work with babies, so it's different, but there's one in my unit now who occasionally still has a 'Mac attack' and sats single digits. She's always been really sensitive and would go from 99% to 9% in a heartbeat. I'm hoping she doesn't have residual damage from all these spells, she always recovers beautifully, but you never know.
    haha I haven't heard of a "mac attack" we call them "death spells". Took care of a baby years ago who literally needed chest compressions every time she pooped...but that's another problem, but she would wake up from it and look at us like to say "what are you all staring at and yelling about? can's a baby poop in peace?" haha. She's still kickin too, and far more appropriate than anyone ever imagined she would be
  7. by   turnforthenurse
    wow, and I thought 50-60% was bad...that was the lowest I have ever seen on a patient.
  8. by   calivianya
    I had a patient who had contracted pneumonia, gone septic, and presented initially with confusion. They checked his sats in the ED and got numbers in the 20s. They didn't believe the reading, did an ABG, and got a PaO2 of 29. They had him on the vent in five seconds flat after that, so by the time he got to me his sats were 100%. It is really something that he was talking to them with a PaO2 of 29, though. He was just getting the day of the week wrong.
  9. by   HyperSaurus, RN
    I just started in a NICU a couple of months ago. I think the lowest I've seen so far was 38%. Scared the crap out of me. On an adult on medical, I think I saw 52%.
  10. by   ICURNBSN
    Yes, I took care of a patient like this as a tech. All the nurses were so worried and amazed the doctor was sending her home with a sat. of 60%!
  11. by   KBICU
    Lowest Pao2 I ever saw was high 20's....ECMO, CCRT, you name it he had it....but he lived
  12. by   Ashley_RN
    2 nights before this past Christmas, I took care of a woman who had end-stage IPF... she was originally admitted for a lung transplant workup & deteriorated very quickly, never able to leave the hospital.... She was ready to transition her care to CMO but wanted to wait for her young daughters to get there & stay 'awake' for them as long as she could (She was only 50yrs old, with 2 girls aged 19 & 21). She did not want to be intubated & was 'tolerating' continuous bipap at its highest settings and by tolerating, I mean any change in position, even shifting to get comfortable, caused her sats to plummet anywhere from the mid-teens to the 30's... It would then take her ATLEAST 10 minutes to recover them back to the low 70's. These episodes would come on at random as well so I spent my whole shift at her bedside, catering to her every need to keep her & her family comfortable in anyway I could. Each time, I held her hand tight & prayed outloud (her request of me) while she got through these episodes. I also spent most of my shift crying, hiding it from her & her girls, as I watched them cry & hug eachother tightly all night. She was placed on a morphine gtt & passed away the following day on Christmas Eve She was the loveliest woman, I think of her & her girls often... I hope they are doing okay.

    The lowest her O2 sat read on the monitor that night was 15%.
    (It was her request to keep the oximeter on, she said it provided her the strength to keep going after each 'recovery')
  13. by   bettina2011
    Im surpired your pulse oximeter is still picking up your patients signal. I find this odd but i do admire your dedication to ur pt and their families.

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