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?

[RN4PatientCare]

I agree SharonH, good NURSING interventions!

[crissrn27, RN]

This isn't my pt, just something me and another nurse at work were discussing (one of her pts) This pt was a women, at home before surgery, so who knows what her baseline usually is. Resp. therapy does our TCDB and get kinda mad when you step on their toes with this......crazy I know. Anyway, I'll let you know what happens, next time I talk with her. Thanks for all the responses!

[Dolce, RN]

I agree with all of the above responses but wanted to add another option. I once cared for a patient who had a simple procedure performed with sedation. We couldn't get her post-op SpO2 >89 on RA. If she TCDB it would go up slightly but would not stabilize. She had a smoking hx so we thought maybe that was it, but a chest x-ray showed pneumonia. Sometimes there is more than one thing going on at once. The decreased sats may not be related to the surgery, only amplified by it. There may be another disease process going on. It would be nice to have the patient evaluated by a pulmonologist.

[crissrn27, RN]

BTW, her sats resting were 77%

[CarVsTree]

BTW, her sats resting were 77%

That kind of screams PE. It can be either a thromus or fat embolism. Atelectasis can cause a sat in the 70's but not as likely as an embolism.

Hope this lady does well.

Respiratory gets mad at you for C&DB for patients. That is ridiculous. I'd tell them where to go!

[crissrn27, RN]

Yeah, thats what I would do as well. Thank goodness I work in the nursery and we rarely need them. Just for vents. I was worried about a PE as well, the only thing they had done at that point was CXRY and that was clear. I'll let you guys know how it turned out!

[RedCell]

Chest films are of little value in dx of PE's. Sounds like the roto-rooter service needs to be consulted. It seems like events in this population always follow the same pattern. Start with a fall, lead to a surgery gone bad, meet and great with a nosocomial infection, progress to a decubitus ulcer, climax with massive septicemia and result in meeting Jesus. All of this is of course accompanied with full code status courtesy of family who think old man Rivers, "just might make it". Big Fortuna for the consulting physicians. Can't wait till I get old.

[SharonH, RN]

Respiratory gets mad at you for C&DB for patients. That is ridiculous.

It's also extraordinarily rare. I've never worked anywhere where it wasn't a chore to get RT to do a treatment outside of their scheduled tx's and even then they were always "on the way". If they thought nursing would do it, they would gladly turn it over!

[crissrn27, RN]

Now keep in mind that the RT stuff is hearsay. Like I said, we don't use them much, we do our own O2, oxyhoods, etc. Just use them for vents. Wouldn't want to sully our RTs reps.