low o2 sats after ORIF?

[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?

[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.

[gt4everpn, BSN, RN]

Whats ORIF again, sorry been out of nrsg school for a while!

[Creamsoda, ASN, RN]

Correct me if im wrong, but I thought I remember hearing somewhere, that a low hemoglobin will not give a low o2 sat, only if there is actually not enough oxygen passing through the lungs into the cells. Because there is less hemoglobin molecules, the oxygen will attach to all the receptors because there are so few to begin with so its a false high o2 sat. They will still feel tired and lethargic because not enough o2 is being transported, but that is because of the limited oxygen carying binding sites. Does that make sense? The sat probe will still see full binding capacity on the hemoglobin, so the sat appears high. A low o2 sat in a post op patient would be more likely related to atelectesis of the lungs, and not taking big enough breaths related to anestesia, pain ect.

[ann945n, RN]

got my money on fat emboli

a low hem wouldnt cause low O2 sat since all the hem (even if there is little of it) will still pick up any O2 it can. O2 sat cant tell low h and h only that O2 aint getting to the RBC

[BULLYDAWGRN, RN]

I think the D-Dimer will be elevated anyway from the inflamation from surgery, I probably get a quick set of abgs and ask for a fast ct-scan for that possible atalectasis or early pneumonia or worse a pe. Cher1983 I believe you are on the money with the false high sat reading.

[momdebo, BSN, RN]

Has the sat value been checked against ABG's?

[matchstickxx]

Whats ORIF again, sorry been out of nrsg school for a while!

Open reduction internal rotation, I think....Not an ortho nurse....can you tell?

[Roy Fokker, BSN, RN]

Open reduction internal rotation, I think....

Almost correct

Open Reduction Internal Fixation :)

Here's the WIKI article...

cheers,

Roy (Ortho/Surgical RN!)

[AlbertaBlue]

Correct me if im wrong, but I thought I remember hearing somewhere, that a low hemoglobin will not give a low o2 sat, only if there is actually not enough oxygen passing through the lungs into the cells. Because there is less hemoglobin molecules, the oxygen will attach to all the receptors because there are so few to begin with so its a false high o2 sat. They will still feel tired and lethargic because not enough o2 is being transported, but that is because of the limited oxygen carying binding sites. Does that make sense? The sat probe will still see full binding capacity on the hemoglobin, so the sat appears high. A low o2 sat in a post op patient would be more likely related to atelectesis of the lungs, and not taking big enough breaths related to anestesia, pain ect.

This is my understanding as well...as with a patient who has methemoglobinemia - their sat's will be reading a falsely normal reading despite the fact that much of their hemoglobin has been taken over by metabolites produced by various different chemical agents. It seems like the most probable explanation for someone who has a low sat, and who happens to also be 87 and post-op, is atelectasis - you just have to get them DB&C - pneumonia in the elderly is a more common without the presentation of surgery. Just some thoughts.

[matchstickxx]

Almost correct

Open Reduction Internal Fixation :)

Here's the WIKI article...

cheers,

Roy (Ortho/Surgical RN!)

Oops....That's what I get for trying to type and talk at the same time and then post without proofreading.

[morte, LPN, LVN]

how low, and what was his baseline preop?..can you hear LS throughout all lung fields? if he was in LTC (not ALf or rest home) he should have some record of PO there, if they dont have them in hosp.....the low hgb would, as suggested by others, give you a HIGH, not a low reading.....

[SharonH, RN]

There are a multitude of reasons that have been given and I agree with almost all of them as a possibility however enough info has not been given. But before you get a VQ scan and a D-dimer, try the incentive spirometer or cough and deep breathe if an IS is not available to you. You would be surprised at how effective this simple nursing intervention is.