pulse oximetry
TRANSCRIPT
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PULSE OXIMETRYprinciple,
applications & interpretation
RAVINDAR BETHI
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PULSE OXIMETRYis one of the most essential monitors for routine use in anesthesia and intensive care
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PULSE OXIMETRYwhat does it measure ?
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PULSE OXIMETRYIt measures the O2 saturation of Hb in arterial blood
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PULSE OXIMETRYIt measures the heart rate
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PULSE OXIMETRYgives an idea about tissue perfusion by pulse wave form
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PULSE OXIMETRYgives an idea about tissue perfusion by pulse wave form
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PULSE OXIMETRYgives an idea about tissue perfusion by pulse wave form
• increased amplitude indicates vasodilatation
Dicrotic notch descends
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PULSE OXIMETRYgives an idea about tissue perfusion by pulse wave form
• decreased amplitude indicates vasoconstriction or hypovolemia
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PULSE OXIMETRYgives an idea about tissue perfusion by pulse wave form
Area under the curve indicates stroke volume
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PULSE OXIMETRYgives an idea about tissue perfusion by pulse wave form
Can be used for assessment of blood flow in re-vascularised limb In re-anastamosed limb In a digit after or during surgery
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The principle
• What is oxygenation of a Hb ?
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The principle
• What is oxygenation ?O2
Oxy HbDeoxy Hb
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The principle
• What is oxygenation ?O2 O2
OxyHb
DeoxyHb
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The principle
• What is oxygenation ?O2 O2
O2
OxyHb
DeoxyHb
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The principle
• What is oxygenation ?O2 O2
O2 O2
OxyHb
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The principle
• What is oxygenation ?O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2
Oxygen saturation = Oxygen contentOxygen capacity
X 100
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The principle
• What is oxygenation ?O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2 O2
O2
Oxygen saturation = Oxygen contentOxyHb+DeoxyHb
X 100
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The spectrophotometry
When a light of particular wavelength passes though a solution sample, the compound of interest absorbs these specific radiations
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The spectrophotometry
When a light of particular wavelength passes though a solution sample, the compound of interest absorbs these specific radiations
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The spectrophotometry
Oxygen saturation = Oxygen contentOxygen capacity
X 100
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The spectrophotometry
Oxygen saturation = OxyHbOxyHb+DeoxyHb
X 100
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The spectrophotometry
Oxygen saturation = OxyHbOxyHb+DeoxyHb
X 100
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The spectrophotometry
Photosensor(2 LEDs)
Photodetector
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Signals from other sources than arterial
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The spectrophotometry& plethysmography
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REFLECTION PHOTOMETRY
ABSORPTION PHOTOMETRY
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REFLECTION PHOTOMETRY
ABSORPTION PHOTOMETRY
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SpO2 vs SaO2ABG RESULT
• SaO2 96 %• PaO2 90 mmHg
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Non functional Haemoglobins SaO2 50%
SpO2 100%
SpO2 vs SaO2ABG RESULT
• SaO2 96 %• PaO2 90 mmHg
Oxy Hb
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Non functional Haemoglobins SaO2 50%
SpO2 100%
SpO2 vs SaO2ABG RESULT
• SaO2 96 %• PaO2 90 mmHg
Oxy Hb
OXIMETRY GAP
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SaO2 vs PaO2
O2
PRESSURE GRADIENT-1
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SaO2 vs PaO2
O2
PRESSURE GRADIENT-1
O2
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SaO2 vs PaO2
PRESSURE GRADIENT-2
O2
O2
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SaO2 vs PaO2
O2
PRESSURE GRADIENT-2
O2
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SaO2 vs PaO2
O2
PRESSURE GRADIENT-1
O2
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SaO2 vs PaO2
O2
PRESSURE GRADIENT-2
O2
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SaO2 vs PaO2
O2
PRESSURE GRADIENT-2
O2
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SaO2 vs PaO2
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SaO2 vs PaO2
PaO2 100mmHg
SpO2 100%
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SaO2 vs PaO2
PATIENT BREATHING
100% O2
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SaO2 vs PaO2
PATIENT BREATHING
100% O2
PaO2 >300SpO2
MAXIMUM 100%
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APPLICATIONS
PATIENT BREATHING
100% O2
PaO2 >300SpO2
MAXIMUM 100%
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APPLICATIONS
PATIENT BREATHING
100% O2
PaO2 <70
SpO2
MAXIMUM 100%
ALKALOSIS, HYPOTHERMIA
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APPLICATIONS
PATIENT BREATHING
100% O2
PaO2 >300SpO2
MAXIMUM 100%
EFFECT OF PREOXYGENATION
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APPLICATIONS
PATIENT BREATHING
100% O2
SpO2
100%
BRONCHIAL ASTHMA
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APPLICATIONS
PATIENT BREATHING
100% O2
BRONCHIAL ASTHMA
ALVEOLAR COLLAPSE
SpO2
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APPLICATIONS
PATIENT BREATHING
60% O2
PaO2 90SpO2
92%
BRONCHIAL ASTHMA
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APPLICATIONS
BRONCHIAL ASTHMA
PATIENT BREATHING
60% O2
PaO2 90SpO2
92%
NITROGENSAVES LIFE
!!
OXYGEN DIFFUSES
OUT
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APPLICATIONS
PATIENT BREATHING
100% O2
PaO2 >300SpO2
MAXIMUM 100%
COPD
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APPLICATIONS
PATIENT BREATHING
100% O2
PaO2 >300SpO2
MAXIMUM 100%
COPDHypercarbia
hypoxia
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TAKE HOME MESSAGES
When SpO2 value can be a false reading?• in Carbon monoxide poisoning• in Methemoglobinemias
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TAKE HOME MESSAGES
Why only 92% in Bronchial Asthma and COPD ?
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TAKE HOME MESSAGES
When SpO2 gives false readings ?• ...in methylene blue therapy, deep
jaundice…
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TAKE HOME MESSAGES
When SpO2 is falsely low ? • Ambient light…tourniquet, • Compartment syndrome with
pulsatile veins…
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TAKE HOME MESSAGES
• When even SpO2 or PaO2 is not just enough …if PaCO2 is low in head injury
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TAKE HOME MESSAGES
• ECG and SpO2 waves in arrhythmias, PEAObserve
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TAKE HOME MESSAGES
Take your own pulse oximetry while holding breath
Observe
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TAKE HOME MESSAGES
• How SpO 2 alone is unreliable as monitor at intubation?
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TAKE HOME MESSAGES
• Why the animals living in high altitudes have a high RBC count ?• Why the RBC count increases in high altitudes?
O2
O2
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In order to use the search light effectively we need to have a fairly thorough knowledge of
all the territory to be searched.