What is the pathophysiology? SPO2 34%

Nurses COVID

Updated:   Published

nurse-understand-pathophysiology.jpg.bae9aae8f11397e7f869ae5ecc9d40f1.jpg

Walkie talkie, good waveform.  Real deal 34%.

Anybody understand the pathophysiology here?

On 11/7/2021 at 6:00 PM, hherrn said:

I'll see what I can find out- but, ABG would be a while after intubation.

Thank you.  Just to be clear, I wouldn't expect you to provide more than very general information in order to protect patient confidentiality; I.e. "ABG's were what one would expect."  I was just thinking that ABG's could perhaps provide a clue to the question you asked in your OP.

1
Up Vote Up Vote ×
Specializes in Critical Care.
On 11/7/2021 at 6:19 AM, hherrn said:

I can follow some of the proposed reasons for the hypoxia, and even the lack of dyspnea. 

But- having trouble understanding how other organs are perfused with so little O2 being delivered.  The brain, for example.  How is enough O2 getting into brain cells to allow higher levels of functioning?

Not expecting definitive answers here- Our medical director also is a bit mystified.

The lack of dyspnea would be because hypoxia generally doesn't cause dyspnea, dyspnea is typically driven by hypercapnea.  That's one of the more dangerous things about hypoxia with normal CO2 levels, the person typically doesn't realize they are severely hypoxic even just prior to losing consciousness.  This is why nitrogen asphyxiation has become a preferred method for assisted suicide.  

With capillary measurement of oxygen saturation you're measuring how much oxygen is still in blood by the time it gets to the fingertips or whereever you are measuring it.  In normal or even most abnormal balances between oxygen absorption and perfusion vs metabolic demand there is still a large amount of oxygen still saturating the blood even at the distal capillaries.  But when that balance is really off vital organs like the brain, kidneys, heart, etc are pretty good at ensuring they are the priority for perfusion, which can leave places like the fingertips on the loosing end of things.

7
Up Vote Up Vote ×
Specializes in Private Duty Pediatrics.
9 hours ago, MunoRN said:

The lack of dyspnea would be because hypoxia generally doesn't cause dyspnea, dyspnea is typically driven by hypercapnea.  That's one of the more dangerous things about hypoxia with normal CO2 levels, the person typically doesn't realize they are severely hypoxic even just prior to losing consciousness.  This is why nitrogen asphyxiation has become a preferred method for assisted suicide.  

With capillary measurement of oxygen saturation you're measuring how much oxygen is still in blood by the time it gets to the fingertips or whereever you are measuring it.  In normal or even most abnormal balances between oxygen absorption and perfusion vs metabolic demand there is still a large amount of oxygen still saturating the blood even at the distal capillaries.  But when that balance is really off vital organs like the brain, kidneys, heart, etc are pretty good at ensuring they are the priority for perfusion, which can leave places like the fingertips on the loosing end of things.

This is a beautiful, clear explanation. Thank you.

2
Up Vote Up Vote ×

Did you say this patient was Covid+ ?

1
Up Vote Up Vote ×
21 hours ago, 2BS Nurse said:

Did you say this patient was Covid+ ?

Yup.

Was hoping to follow up on ABG, outcome, etc.
Unfortunately, I sarted my day with 3 boarded patients I am not quailfied to care for.  Before I was done getting report, I picked up an ambulance- withdrawl seizure.  Before I even saw my 90year old covid PT, I had also picked up, and discharged, a second seizure pt.  

 

1
Up Vote Up Vote ×
+ Add a Comment