NICU Bradycardia and desaturations on monitor

[healthxo33, BSN, RN]

I am a new graduate neonatal intensive care unit nurse. I am having trouble figuring out how I can tell if a bradycardia or a desaturation on the cardiorespiratory monitor is real or not. I tried searching things on Google and trying to find pictures online to show me the difference but I have not been successful.
 

Can somebody please explain to me how I can tell if a bradycardia and desaturation are real? I believe there’s a way to go back into the monitor to view the lowest point of the bradycardia and desaturation. How do the respirations look when there is a bradycardia or a desaturation? Do the respirations always have to drop or be shallow for a brady or desaturation to occur?

I’m having trouble with looking at the monitor and figuring out where the brady or desat occured when I look at the wave forms. 

[NICU Guy, BSN, RN]

First look at the EKG: Is the waveform level across the screen (accurate) or does it have a wandering baseline (inaccurate).

The same for the SaO2: If the waveform is level across the screen (accurate). If it has a wandering baseline (inaccurate). 

Compare the HR number (from the EKG) and the Pulse (from the SaO2). If they are not within a few beats of each other, then one is inaccurate. 

Look at the patient: Are they blue, dusky, ashen?

Essentially, if you have a level baseline on either EKG or SaO2, then that reading is accurate. Wandering baseline on EKG, not accurate. Wandering baseline on SaO2, not accurate.

Respirations on a monitor can be accurate to very inaccurate. The respirations on the monitor are derived from the EKG leads. You need a level EKG baseline, patient is not laying on one of the EKG patches, patient not moving around to be accurate. Manually count their respirations or read the RR off the ventilator (if they are on a ventilator) if the reading on the monitor seems inaccurate (you look at the patient and estimate they are breathing 60-80 breaths per minute but monitor reads 16).

[Leader25, ASN, BSN, RN]

On 7/29/2021 at 12:43 AM, healthxo33 said:

How do the respirations look when there is a bradycardia or a desaturation? Do the respirations always have to drop or be shallow for a brady or desaturation to occur?

I’m having trouble with looking at the monitor and figuring out where the brady or desat occured when I look at the wave forms. 

Did you complete NALS?,take the hospital ekg neonatal test? If not make sure you get those under your belt. The rest you must decide sooner if a neonate is in trouble, it would take to long to go look at screen recordings when the patient is already struggling and you have not noticed their distress. Remember they can not tell you I am choking from reflux or my airway is blocked, my ETT  has secretions.

Look at your patient, make sure he is safe ,then you can go about fiddling with the monitor,checking if leads,oxymeter tape ,and everything else is correct. HR on monitor should  almost match hr on oxymeter,Abgs wnl ? is it artifact,crying,motion,did infant respond to tactile stim?The only true confirmation is an echo,cardiologists analysis.

Good luck