low o2 sats after ORIF?

Nurses General Nursing

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Specializes in nursery, L and D.

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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Specializes in Internal Medicine Unit.

Pain or sedation resulting in shallow breathing or slowed respiration rate? I've seen it with other procedures.

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Specializes in Pediatrics Only.

Anesthesia or meds? Thats my best guess...

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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.

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Specializes in nursery, L and D.

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!

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Specializes in Med/Surg, Ortho.

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.

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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.

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Specializes in ER/Trauma.

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!
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Specializes in CRNA.
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.

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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

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Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

Pickwickian? Big Belly and having to lie flat?

Did you account for your patients age in the offset before determining the O2 sats?

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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.

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