PULSE by Nick Mark MD

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.com
Link to the
most
current
OXIMETRY
PRINCIP
LE:
Pulse oximetry is the non-invasive continuous measurement of the oxygen saturation of hemoglobin. It
exploits the fact that oxy- & deoxy hemoglobin
E @nickmma
rk
version →

The plethysomograph Amplitude may Perfusion

differentially
Shine Red and IR light absorb
through the skin and
DeoxyHbred and infra-red
and OxyHb
have different light
light
The signal that varies .
with time represents the
Using a standard curve, the ratio waveform shows signal increase with index indicates
of Red/IR absorption over time, greater SV the signal
measure the absorption absorption profiles pulsatile blood flow. (modulation ratio) is used to corresponding to pulse (such as after a strength
calculate the SaO2 pause)
10 Red (660 IR (940 R
Red 0% nm) nm) eI
IR
LED LED 8 dR Red > H
0 IR

8
R
% OxyHb
6
0
%
4 S P

5
0 DeoxyHb 0

9
p I
% R
O
2 eI 2 .
Photodiode 0 CarboxyHb dR IR >
% 8
0% Red
20 40 60 80 100

6
600 700 800 900 1000
Wavelength (nm) SaO2 (%) PTT Oxygen Saturation
M
A Pulse transit time represents the value (SpO2); value is
ACCURACY OF PULSE o
b interval from EKG R wave to PPG calculated from the curve
OXIMETRY: d
Several factors s peak; determined by arterial and averaged over 3-6
u
compliance
can affect the accuracy of pulse ox
PROBE TYPE
The pulse POSITIONING
o
r
oximeter probe
&
can be applied
LOW FLOW STATES l
Low perfusion states (such asa due to
LOWER ACCURACY AT
LOW SPO2
Because the calibration curve was PLETHYSMOGRAPH
sec

imetry readings
to different locations.p
· Finger – t
high vasoconstriction or low tcardiac
output) can make
developed using healthy volunteers,
The plethysmography Systoli
Y
waveform has systolic & c peak
Δ
Diasto
lic
i
, including:
most accurate
i
the pulse oximetry
o ; thumb
o measured SpO2 ca diastolic components;
WAVEFORM
examination ANALYSIS
can provide
peak T

may be more accurate

signal weak Ror ev
n than other
n
n differ from SaO2 s physiologic clues about
vascular tone/compliance.
fingers. Uses a transillumination
method to measure. (en undetectable ignificantly HYPEROX
Hyperoxia is harmful
EMIA at low
(particularly afterva
SYST DIAST
OLE OLE

Forehead
· Ears &
%
. This can make
)
monitoring
ABNORMAL i with
– slightly
a
t
SpO2 lues
cardiac arrest) but pulse
difficult or impossible in patients (e.g. an SpO2 less than 75%). NORMAL
(MetHb) oximetry cannot differentiate normal from
less accurate but may be HEMOGLOBIN
· Methemoglobinemia
non-pulsatile o causes
flow such as patients on supra-normal PaO2 if the SpO2 is 100%. VENOUS
more reliable in va spurious reading a
ECMO or with an LVAD.
(
, Target SpO2 ≥94%
PULSE
It takes time for OX
blood to flow from heart
WEAK SIGNAL
· ↓↓ perfusion index
PULSATIONS (SEVERE
TR)

soconstricted stat typically an SpO2 in the 85-88%

R
LAG TIM
to skin, as a result pulse ox · try alternate positions/probes
·

SKIN COLOR & NAIL

es oximetryPOLISH
range. ) measurements lag by 5 – 15 seconds. Late/promi
Pulse · Carboxyhemoglobinemia (CoHb)
causes a false normal reading with SpO2 E
Lag time may be shorter if probe is
placed more centrally on nent diastol
may overestimate
or hypothermia ; uses in the 94-100% range. Patients are VASOCONSTRICT VASODILATED
ic peak
SpO2
backscatter in dark skinn
method to measure.
hypoxic due to inability to unload O2
from Hb. (left shifted HbO2 curve) forehead/ears, & longer if ED
· ↑ diastolic peak
· ↑ systolic peak,↓ diastolic peak
· upsloping
Longer PTT, longer/undefined
diastolic phase
No probe type is clearly superior; trial & cardiac output is low. This is why SpO2
ed
error individuals
may identify the best probe type
for an individual patient.
· Sulfhemoglobin causes a spurious low
SpO2 reading but patients may not be may continue to drop a few seconds after
MEDICATION
successful intubation.
· Shorter PTT, shorter ΔT
· ↓ perfusion index
ΔT
· ↑ perfusion index
CO-
(compared with SaO2 on ABG), hypoxic (right shifted HbO2 curve) Instead of the two wavelengths
particularly when patients are hypoxemic. · HbA1c > 7 may
Methylene blue,EFFECTS
isosulfan blue, OXIMETRused by standard
fluorescein, & indocyanine green can pulse oximeters, co-oximetry uses 4 wavelengths
Y
Black cause overestimat transiently cause falsely low SpO2
readings.
to accurately measure abnormal hemoglobins.