O2 is 81, what shoud you do?

[victorsunshine]

If a patient's O2 sat 81, what should a Neuro ICU nurse do? If a patient is low blood pressure, what should you do also?

Please help with these two scenario questions, I am preparing for a Neuro ICU interview next week.

[dawngloves, BSN, RN]

Calm, intelligent, and common sense decisions are always better for pts than someone who 'jumps' at a number on a monitor.

Good advice. Look at the pt, no the monitor. If the pt is awake and pink, check first that the pulse ox is on. I have gotten a sat reading off of many a bed, (frighteningly enough).

[RazorbackRN, BSN, RN]

Just becasue someone doest jump at a problem doesnt make the problem not exist. 81% sustained for anyone is too low. I personally am very interested to hear your rationale behind why an Sp02 of 81@ on a Neonate, let alone an adult isnt a concern to you? Ive worked in critical care, Respiratory Therapy and with neonates and this is the first time Ive ever heard this one?

Perhaps you've not worked in a pediatric CV area?

Take a baby with a cyanotic heart condition, for example HLHS. An sp02 of 81% is perfectly acceptable, even desirable, as a "normal" sp02 could be damaging in the long run to this child.

This isn't something that is later corrected either (unless they're transplanted). They will more than likely live with sats in the 75-85% range all of their lives.

[bmxRRT]

To the original poster: assess the patient for distress, correlate sp02 rate with palpable heart rate to ensure good quality sp02 signal. Check oxygen delivery device and flow, is it enough for this patient? If not on oxygen, put them on a cannula to start, 2lpm lets say. Wheezing/Diminished/Coorifice? Bronchodilator time! Etc...it takes good patient assessment skills and putting all the pieces together to provide a patient with a low sat with the correct treatment.

Don't always jump to give the patient medication/drugs just yet!

If the patient is QUICKLY deteriorating, thats another story, ensure proper resuscitation equipment is at hand. Drop HOB to supine, open airway, etc...follow ACLS or BCLS protocol.

[eider]

can i join in...? we're talking about a neuro patient--presumably a head injury patient...? there's always that possibility of cerebral edema, hence increased ICP...with regards to low sats and low BP...would you do a trendelenburg? how should we prioritize? trendelenburg can increase intra-thoracic pressure and maybe put pressure on the carotids causing more problems with the ICP...but hypotension and decreased sats can also decrease cerebral perfusion...this has always been a dilemma for me...is it really safe to do trendelenburgs in neuro? thanks...

[XB9S, BSN, MSN, EdD, RN, APN]

Elder, our neuro surgeons would have a fit if you nurse a patient head down because of the risk of increase ICP, to be honest in ICU if the patient was desaturating and hypotensive it would revert back to ABC.