Abnormal Pulse Oximetry Research Articles

Normal Value of Perfusion Index in Healthy Neonates Born in Iran

Background: Perfusion index is a dependable indicator for assessing the perfusion status of newborns. A low perfusion index indicates compromised hemodynamic function. The study aims to investigate perfusion index in asymptomatic newborns aged 35 to 41 weeks who did not require medical support. Methods: Healthy neonates born in four major maternity hospitals of Tehran University from 2019 to 2021 were selected. To ensure consistency and reliability in data collection, a detailed manual was developed and distributed, along with comprehensive training sessions for all personnel involved. Results: A total of 994 newborns entered the study. Among them, echocardiography was adversely affected in 218 neonates due to abnormal screening pulse oximetry. Of these 218 neonates, 53 were found to have abnormal echocardiography results. The median perfusion index value in healthy neonates was 1.6%, and the median oxygen saturation was 97%. A percentile perfusion index curve was developed for healthy neonates to establish a normal reference range. Conclusion: Developing a percentile perfusion index curve specific to healthy neonates provides a useful reference range for healthcare providers to assess perfusion status in this population, but further research is needed to confirm its accuracy.

Comparative Performance of Different Respiratory Test Parameters for Detection of Early Respiratory Insufficiency in Patients With ALS.

To compare the performance of different respiratory function testing parameters in a multidisciplinary amyotrophic lateral sclerosis (ALS) clinic. Demographics, clinical data, and respiratory testing parameters were abstracted from the medical records of patients who attended a multidisciplinary ALS clinic from 2008 to 2016. We compared the performance of the 3 primary respiratory test parameters used by Medicare for the initiation of noninvasive ventilation (NIV) (forced vital capacity [FVC] < 50% predicted, maximum inspiratory pressure [MIP] < 60 cm H2O, and abnormal overnight pulse oximetry [OvOx]) on how they related to several clinically relevant attributes. Four hundred seventy-six patients were identified who underwent at least 1 respiratory test. Abnormalities of OvOx, MIP, and FVC occurred at a median of 1.6, 1.5, and 3.8 years from disease onset, respectively (p < 0.00001). Patients with bulbar-onset ALS exhibited earlier abnormalities in MIP and FVC than in spinal-onset ALS (p < 0.005). The median survival after an abnormal OvOx, MIP, or FVC test was 1.4, 1.4, and 0.9 years, respectively (p < 0.0001). Using the ALS Functional Rating Score respiratory subscales, at the time of reported respiratory symptoms there were abnormalities in OvOx (60%), MIP (69%), and FVC (19%). Conversely, when respiratory parameter abnormalities preceded reported respiratory symptoms, this occurred with frequencies in OvOx (79%), MIP (42%), or FVC (24%). Four hundred forty-three patients (93.1%) developed at least 1 abnormal respiratory measure meeting Medicare criteria for NIV consideration, but fewer than 50% in our cohort demonstrated NIV use. Improved survival in subjects using NIV was statistically significant in patients with bulbar-onset ALS. Abnormalities in OvOx and MIP perform better than FVC at early detection of neuromuscular respiratory weakness in ALS. Initiation of NIV in patients with respiratory insufficiency may improve the overall survival in ALS. In the setting of the COVID-19 pandemic, FVC and MIP have not been routinely performed because of infectious aerosol generation. OvOx, which we now routinely mail to patients' homes, has been used exclusively during the COVID-19 pandemic and allows for continued remote monitoring of the respiratory status of patients with ALS. This cohort study provides Class III evidence that in people with ALS, OvOx and MIP are valuable respiratory parameters for the detection of early respiratory insufficiency.

Pulse oximetry for the diagnosis of vascular injury following limb trauma

Prompt diagnosis and intervention are essential for acute limb ischaemia after trauma. Guidelines for diagnosis are changing with new evidence. Pulse oximetry may be a useful adjunct. We aim to assess the value of pulse oximetry and other common tests for diagnosing vascular injury.Electronic medical records of patients with limb injuries were identified. Patient demographics, the mechanism of injury, comorbidities, the results of diagnostic tests or examinations, and the end outcome were extracted. Receiver Operator Characteristics (ROC) curves were used to calculate cut-offs with optimum sensitivity and specificity for pulse oximetry. Performance characteristics to predict vascular injury for all documented tests were calculated and compared.SpO2 values were significantly different in the group with and without vascular disruption (p = 0.034). Using a cut-off of 96% calculated from ROC curve analysis, SpO2 had a sensitivity of 78% and a specificity of 90%. For the other techniques, abnormal pulse oximetry waveform, absent distal pulses, and capillary refill over 2 s were significantly different between the two groups. Abnormal pulse oximetry waveform had the highest specificity (100%) while SpO2 was the most sensitive (78%).We suggest that pulse oximetry is a useful adjunct for patients with limb trauma, an abnormal waveform or SpO2 value below 96% suggests vascular disruption is present. Capillary refill over 2 s and absent distal pulses can also be used; if either are positive, this suggests vascular disruption. No test or examination was shown to be able to exclude vascular injury.

Lessons Learned from Infants with Late Detection of Critical Congenital Heart Disease.

Late detection of critical congenital heart disease (CCHD) is multifactorial and ill defined. We investigated the results of pulse oximetry screening (POS) and points in the care chain that contribute to delayed detection of CCHD. The medical records of 13 infants with delayed detection at a single pediatric cardiac center between 2013 and 2016 were identified and reviewed. Left heart obstructive lesions were the most common diagnosis (n = 8; 62%) and included coarctation of the aorta (n = 6), interrupted aortic arch with ventricular septal defect (n = 1), and critical aortic stenosis (n = 1). Tetralogy of Fallot (TOF) (n = 2), truncus arteriosus (n = 1), pulmonary atresia with ventricular septal defect (n = 1), and total anomalous pulmonary venous drainage (n = 1) made up the remainder of the conditions. Routine prenatal care was reported in most infants (10/13). Infants with late detection had either a true negative POS (10/13 infants) or no POS performed (3/13 infants). At the time of detection, 5/6 (83%) infants with coarctation had normal pulse oximetry values, whereas 6/7 (86%) infants with other CCHD developed abnormal pulse oximetry values. At diagnosis, 11/13 (85%) infants had significant signs or symptoms of clinical deterioration; only 2 infants were completely asymptomatic. Late detection of CCHD is uncommon and multifactorial. Eliminating late detection is dependent upon improving detection on screening obstetrical ultrasounds, enforcement of universal POS, and attention to the neonatal physical exam.

Correlation between Emergency Medical Services Suspected COVID-19 Patients and Daily Hospitalizations

Objective: We sought to determine if Emergency Medical Services (EMS) identified Persons Under Investigation (PUI) for COVID-19 are associated with hospitalizations for COVID-19 disease for the purposes of serving as a potential early indicator of hospital surge. Methods: A retrospective analysis was conducted using data from the Maryland statewide EMS electronic medical records and daily COVID-19 hospitalizations from March 13, 2020 through July 31, 2020. All unique EMS patients who were identified as COVID-19 PUIs during the study period were included. Descriptive analysis was performed. The Box-Jenkins approach was used to evaluate the relationship between EMS transports and daily new hospitalizations. Separate Auto Regressive Integrated Moving Average (ARIMA) models were constructed to transform the data into a series of independent, identically distributed random variables. Fit was measured using the Akaike Information Criterion (AIC). The Box-Ljung white noise test was utilized to ensure there was no autocorrelation in the residuals. Results: EMS units in Maryland identified a total of 26,855 COVID-19 PUIs during the 141-day study period. The median patient age was 62 years old, and 19,111 (71.3%) were 50 years and older. 6,886 (25.6%) patients had an abnormal initial pulse oximetry (<92%). A strong degree of correlation was observed between EMS PUI transports and new hospitalizations. The correlation was strongest and significant at a 9-day lag from time of EMS PUI transports to new COVID-19 hospitalizations, with a cross correlation coefficient of 0.26 (p < .01). Conclusions: A strong correlation between EMS PUIs and COVID-19 hospitalizations was noted in this state-wide analysis. These findings demonstrate the potential value of incorporating EMS clinical information into the development of a robust syndromic surveillance system for COVID-19. This correlation has important utility in the development of predictive tools and models that seek to provide indicators of an impending surge on the healthcare system at large.

Correlation Between Ankle Brachial Index and Lower Limbs Digital Pulse Oximetry: A Referral Center Experience, Prevalence Study

ObjectiveAnkle-brachial index (ABI) is widely recommended and used to evaluate peripheral arterial disease. The oxygen saturation (SpO2) has been associated with ABI, showing a promising clinical practice utility; however, little literature regarding this matter has been reported. This study aims to assess the correlation between pulse oximetry and ABI. MethodsA cross-sectional study was conducted using ABI measuring devices, such as the MESI® Ankle Brachial Pressure Index (ABPI) (MESI, Ltd., Slovenia, EU) and pulse oximetry. We compared the SpO2 distribution by using the Wilcoxon test and evaluated its correlation by using logistic regression. ResultsFrom a total of 86 patients, 54 were males (62.8%) and the median age was 54 years old (interquartile range (IQR) = 37 - 65 yrs.). Regarding ABI measurements of the right lower limb (RLL), a total of 20 patients (22.3%) had an abnormal classification. On the other hand, a total of 21 patients (22.1%) had an abnormal classification of the left lower limb (LLL) ABI measurements. The distribution of SpO2 in relation to ABI categories was not statistically different (RLL p = 0.2433; LLL p = 0.1242). The SpO2 classification of ABI and abnormal pulse oximetry for the RLL was at 76.7% and at 77.9% in the LLL (Pearson’s goodness-of-fit test: RLL = p < 0.001 and LLL = p < 0.001). ConclusionAlthough we didn’t observe any statistical differences in the SpO2 distribution regarding ABI measurements, in their correlation, there seems to be a different tendency. The SpO2 might be a useful non-invasive tool to assess asymptomatic patients with risk factors for peripheral arterial disease (PAD).

Evaluation of Pulse Oximetry in the Early Diagnosis of Cardiac and NonCardiac Diseases in Healthy Newborns

Background: Critical congenital heart diseases (CCHDs) are among the most common birth malformations. This study aimed to determine the cardiac and noncardiac diseases in the Iranian healthy newborns using pulse oximetry (POX) as a suggested screening method.Methods: In this cross-sectional study, healthy term and near term neonates who were born from October 2017 to March 2018 were evaluated. Preductal and postductal POX was performed in all asymptomatic healthy newborns after 24 hours of life or at any time before discharge from the nursery. Oxygen saturation (SPO2) was considered normal if SPO2 was  95%, and the difference between preductal O2 saturation and postductal POX was obtained at ≤ 3%. The POX was repeated after 2 hours for abnormal patients. In the case of the same results in both repeated measures, echocardiography, chest X-ray, sepsis screening, and blood glucose were conducted.Results: A total of 413 asymptomatic healthy term and near term neonates underwent the pulse oximetry screening (POX). The mean birth weight and gestational age of the neonates were 3256.31±509.62 gr and 38.2 weeks, respectively. The POX was performed averagely 19.5 hours after birth. Finally, a total of 10 cases were detected with abnormal POX. Among these 10 patients, three cases had cardiac diseases (i.e., transposition of the great arteries, ventricular septal defect/pulmonary atresia, and ventricular septal defect/pulmonary hypertension), three cases had noncardiac diseases (i.e., esophageal stenosis, hypoglycemia, and persistent pulmonary hypertension/sepsis), and four subjects were healthy.Conclusion: The obtained findings showed that routine pox, along with clinical examinations could be applied, especially in developing countries for the early detection of cardiac and noncardiac diseases in asymptomatic newborns.

A Comparative Study of Pulse Oximetry Screening and Clinical Examination in Diagnosis of Congenital Heart Disease

Background: Pulse oximetry is a reliable and non-invasive method for measuring oxygen saturation and has a rapid response. During the past several years pulse oximetry has gained wide spread use in the neonatal oxygen monitoring. The present study was done to determine if a pulse oximetry screening combined with clinical examination is superior in the diagnosis of congenital heart disease to clinical examination alone. Subjects and Methods: The term new-born babies born in NARAYANA medical college and Hospital during the study period of 12months (February 2018 to January 2019) had a thorough clinical examination on day 2 of life with emphasis on peripheral pulses, cyanosis, tachypnea, cardiac pulsations and murmurs. Pulse oximetry screening was done within 4hrs of birth and at 48-72hrs of life. Chest X-ray, ECG and Echocardiogram were done for those babies with either abnormal clinical examination or pulse oximetry reading.Clinical examination was done again 2 weeks after discharge. Results: Though routine clinical examination is effective in detection of congenital heart disease in new-borns, combining pulse oximetry and clinical examination after birth had a higher sensitivity for detection of congenital heart diseases in new-borns. Conclusion: Combining clinical examination and pulse oximetry can enhance the clinician’s ability to detect life-threatening congenital heart disease in a timely manner. This issue requires the formulation of national policy that will make screening for CCHD a priority.

Effectiveness of a Pulse Oximetric Screening for the Detection of Congenital Heart Disease in Asymptomatic New-Borns- An Observational Study.

Background: This study was designed to evaluate the effectiveness of routine postnatal clinical examination and pulse oximetry screening in detecting congenital heart disease in new-borns. Subjects and Methods: The term new-born babies born in narayana medical college and Hospital during the study period of 12months had a thorough clinical examination on day 2 of life with emphasis on peripheral pulses, cyanosis, tachypnea, cardiac pulsations and murmurs. Pulse oximetry screening was done within 4hrs of birth and at 48-72hrs of life. Chest X-ray, ECG and Echocardiogram were done for those babies with either abnormal clinical examination or pulse oximetry reading. Clinical examination was done again 2 weeks after discharge. Results: The sensitivity 26% for oximetry alone and 60% for clinical examination alone. Specificity was 99.8% for pulse oximetry alone, and 98% for clinical examination alone. Conclusion: Pulse oximetry can enhance the clinician’s ability to detect life threatening CHD in a timely manner.

Evaluation of Neonates With Suspected Congenital Heart Disease: A New Cost-Effective Algorithm.

We assessed the value of existing guidelines for the evaluation of suspected congenital heart disease (CHD) in term neonates and propose a revised algorithm. Retrospective chart review of newborns referred for cardiac evaluation at a tertiary care center was performed. A total of 777 newborns qualified for the study. Among these, 3 critical and 8 major CHD were identified. The sensitivity of the combination of abnormal physical examination and pulse oximetry screening for major and critical CHD was 100%. The cost to detect a case of critical CHD, based on echocardiograms done for all abnormal electrocardiograms, was 3.4 times more than that incurred for performing this test on the basis of abnormal pulse oximetry and physical examination. Adding electrocardiogram to CHD screening increases cost without adding diagnostic yield. Based on our findings, we propose a revised algorithm for a systematic cost-effective approach to cardiac evaluation of term newborns with suspected CHD.

Predictors of safe discharge for pediatric drowning patients in the emergency department

ObjectivesThe purpose of this study is to determine if stable, well-appearing, drowning patients who have normal age-adjusted vital signs and pulse oximetry upon arrival to the emergency department may be safely discharged without a prolonged observation period. MethodsMedical records were retrospectively reviewed for drowning patients presenting to a single pediatric emergency department from 1995 to 2014. Data were collected on vital signs and pulse oximetry at presentation, chest x-ray results, disposition and complications for each encounter. Patients were identified as having either normal or abnormal initial vital signs and pulse oximetry, and were compared based on disposition and complication rates. ResultsTwo hundred seventy-six records were initially evaluated and 91 were excluded. Thirty-six percent had normal age-adjusted vital signs upon arrival. Patients with abnormal temperature, respiratory rate or pulse oximetry, as well as those with any abnormal initial cardiopulmonary physical exam findings, abnormal mental status, or chest radiograph findings, were more likely to be admitted to the hospital. Eight patients developed respiratory complications after presentation to the emergency department. Those with abnormal pulse oximetry readings on arrival were more likely to develop complications. Only two patients who developed complications had initially normal vital signs and each had evidence of clinical deterioration within 1h of arrival. ConclusionsThe overall complication rate in initially stable, well-appearing drowning patients is low. An abnormal pulse oximetry reading at presentation may help predict subsequent complications. Those patients with normal age-adjusted vital signs and physical exam at presentation may not require a prolonged observation period.

Age and seasons influence on at-home pulse oximetry results in children evaluated for suspected obstructive sleep apnea

BackgroundSeasonal variability on obstructive sleep apnea has already been studied by polysomnography in children. Winter and spring season emerged as critical periods. No data are currently available for pulse oximetry performed at home. The aim of our study was to evaluate the effect of seasonality and age on the results of at-home pulse oximetry performed in children referred for suspected OSA.MethodsWe retrospectively studied 781 children (64.3% Males), aged 4.9 ± 2.5 years. For all patients, we evaluated both pulse oximetry metrics and the McGill Oximetry Score. Variables for seasonal groups were assessed using Kruskal-Wallis test. A logistic regression model was performed to assess the relationship between patients’ main characteristics, season period and the likelihood to have an abnormal McGill Oximetry Score.ResultsPatients recorded during winter were significantly younger (p < 0.02), nadir SpO2 was significantly lower (p < 0.002) and DI4 significantly higher than during others seasons (p < 0.005). Moreover, patients recorded during winter were nearly 2 times more likely to have an abnormal MOS (aOR 1.949). The logistic regression showed that also younger age (p < 0.0001) was associated with a higher risk to find an abnormal pulse oximetry.ConclusionsIn our study, the winter season confirms to be a critical period for pulse-oximetry and it should be taken into account by clinicians for a correct interpretation of tests. Our data show that also younger age affects the prevalence of abnormal at-home pulse oximetry in children.

Pulse Oximetry and Auscultation for Congenital Heart Disease Detection.

Pulse oximetry (POX) has been confirmed as a specific screening modality for critical congenital heart disease (CCHD), with moderate sensitivity. However, POX is not able to detect most serious and critical cardiac lesions (major congenital heart disease [CHD]) without hypoxemia. In this study, we investigated the accuracy and feasibility of the addition of cardiac auscultation to POX as a screening method for asymptomatic major CHD. A multicenter prospective observational screening study was conducted at 15 hospitals in Shanghai between July 1, 2012, and December 31, 2014. Newborns with either an abnormal POX or cardiac auscultation were defined as screen positive. All screen-positive newborns underwent further echocardiography. False-negative results were identified by clinical follow-up, parents' feedback, and telephone review. We assessed the accuracy of POX plus cardiac auscultation for the detection of major CHD. CHD screening was completed in all 15 hospitals, with a screening rate of 94.0% to 99.8%. In total, 167 190 consecutive asymptomatic newborn infants were screened, of which 203 had major CHD (44 critical and 159 serious). The sensitivity of POX plus cardiac auscultation was 95.5% (95% confidence interval 84.9%-98.7%) for CCHD and 92.1% (95% confidence interval 87.7%-95.1%) for major CHD. The false-positive rate was 1.2% for detecting CCHD and 1.1% for detecting major CHD. In our current study, we show that using POX plus cardiac auscultation significantly improved the detection rate of major CHD in the early neonatal stage, with high sensitivity and a reasonable false-positive rate. It provides strong evidence and a reliable method for neonatal CHD screening.

Detection of Hb Rothschild HBB: c.[112T>A or 112T>C], Through High Index of Suspicion on Abnormal Pulse Oximetry

We describe a case with a low oxygen affinity hemoglobin (Hb) variant who presented with cyanosis in the absence of cardiopulmonary disease. The patient, a 27-year-old pregnant female (P1G2), complained of a productive cough and bluish discoloration of the lips that started 3 days prior to seeking attention. She had no previous episodes and has generally been in good health. A positive family history of cyanosis was obtained in one sibling. Systematic examination, notably the cardiorespiratory system, revealed no abnormalities. The arterial Hb oxygen saturation (SpO2) on pulse oximetry was 81.0% and Hb separation studies revealed an Hb variant identified as Hb Rothschild [β37(C3)Trp→Arg] (HBB: c.[112 T>A or 112 T>C]) by gene sequencing. The amino acid substitution (Trp→Arg) is an important contact point at the α1β2 interface and favors a T-quaternary state of the Hb tetramer. This leads to a low oxygen affinity state, which results in premature release of oxygen and drop in oxygen saturation. In the absence of cardiopulmonary disease, a decreased oxygen saturation reading, with or without cyanosis, should arouse suspicion for a possible dysHb.

At-home pulse oximetry in children undergoing adenotonsillectomy for obstructive sleep apnea.

In our study, children with OSA who subsequently needed T&A showed higher PRV compared to those without surgical indication. Children with abnormal MOS were nearly 20 times more likely to undergo T&A. What is Known: • Nocturnal pulse oximetry has a high positive predictive value for polysomnographically diagnosed obstructive sleep apnoea in children. • When significant adenotonsillar hypertrophy is diagnosed, adenotonsillectomy represents a common treatment for OSA in children. What is New: • An abnormal pulse oximetry highly predict the indication for adenotonsillectomy. • We suggest the use of at-home pulse oximetry as method to predict prescription of adenotonsillectomy, and this may be useful in contexts where polysomnography is not readily available.

Poppers Not Only Make You High: A Rare Case of Amyl Nitrate-Induced Hypoxia

SESSION TITLE: Fellow Case Report Poster - Pulmonary Physiology SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: “Poppers” are inorganic nitrites that have become an increasingly popular recreational inhalant. They cause vasodilation, smooth muscle relaxation, and aphrodesia. Amyl nitrites act as oxidizing agents which can cause methemoglobinemia. As a result, tissue hypoxia occurs from decreased oxygen binding capacity of methemoglobin. CASE PRESENTATION: A 55 year old male with occasional cocaine use and no significant medical history presented with slurred speech for one day. Initial vital signs showed BP 122/73, HR 64, RR 18, Tm 97.2, SaO2 84% on room air. Physical examination was notable for lethargy and slurred speech. There was no facial asymmetry or focal deficits noted. Blood work was remarkable for Na 147 and Hgb 11. Urinalysis was positive for cocaine. CT head and brain MRI were negative. Patient was given IVF with resolution of symptoms. He was noted to be persistently hypoxic without symptomatology. CT angiogram of the chest was negative for pulmonary embolism. ABG showed pO2 142 and O2 sat of 92% on 2L NC, and co-oximetry disclosed a methemoglobin level of 0.5%. Transthoracic echocardiogram with bubble study ruled out an intra-atrial shunt, and no other etiology for persistent hypoxia could be determined. On directed questioning, the patient admitted to using a combination of cocaine, tylenol PM and “poppers” the night before onset of symptoms. Patient was educated about complications from drug use. His oxygen saturation normalized spontaneously and patient was discharged with pulmonary follow up. DISCUSSION: A low oxygen saturation by pulse oximetry measured in patients with normal arterial blood gases can be an indication of methemoglobinemia. Intravenous (IV) methylene blue is the first-line antidotal agent. Additional adverse effects from poppers include retinal toxicity, esophageal burns, memory impairment, neuropathy, and coma. CONCLUSIONS: This case serves to demonstrate how methemoglobinemia may not always be detected on routine co-oximetry. A fixed abnormal pulse oximetry without an alternate etiology for hypoxia in the setting of methemoglobinemia should prompt a more thorough history. Polysubstance abuse in which cocaine and amyl nitrite is combined may predispose individuals to develop methemoglobinemia with greater severity. In the absence of measured methemoglobinemia, clinicians managing patients with unexplained cyanosis or hypoxia must consider the possibility of acute nitrite toxicity, particularly in patients with a recent or remote history of substance abuse. Reference #1: Edwards R.J., Usma, J. et al. Extreme methaemoglobinaemia secondary to recreational use of amyl nitrite. J of Accident and Emerg Med 1995 12,138-142 Reference #2: Faley B, Chase H. A Case of Severe Amyl Nitrite Induced Methemoglobinemia Managed with Methylene Blue. J Clin Toxicology 2012, 2:4 Reference #3: Hunter L, Gordge L, et al. Methaemoglobinaemia associated with the use of cocaine and volatile nitrites as recreational drugs: a review. Br J Clin Pharmacol 2011 72: 18-26 DISCLOSURE: The following authors have nothing to disclose: Coral Olazagasti, Janvi Paralkar, Michael Vishnevetsky, Aloke Chakravarti, Roxana Sulica, Kristine Favila No Product/Research Disclosure Information

Hb Grifton [α87(F8)His→Pro; HBA1: C.263A > C (or HBA2)] Causes Abnormal Pulse Oximetry Measurements

An asymptomatic toddler and his mother consistently demonstrated low transcutaneous pulse oximetry (SpO2) measurements, discordant with normal arterial blood gas analyses while breathing room air. Previous evaluations by medical teams were unable to identify an etiology of their perceived hypoxia. Further investigation revealed that the boy carried an abnormal variant, Hb Grifton or α87(F8)His→Pro; HBA1: c.263A > C (or HBA2), discovered on newborn screening, which was not suspected as the underlying cause of his abnormal pulse oximetry readings until an inpatient admission to our hospital for asymptomatic “hypoxia,” where he was found to share these same characteristics with his mother. We showed that a difference in light absorption between the oxygenated Hb Grifton variant and oxygenated Hb A resulted in erroneous pulse oximetry values. This phenomenon has previously been reported in a handful of other variant Hbs. Astute clinical suspicion, in conjunction with laboratory testing leading to correct diagnoses of variant Hbs, may prevent expensive work-ups and unnecessary medical treatments for asymptomatic patients falsely presumed to be hypoxemic based on low pulse oximetry measurements.

Organophosphate Poisoning Simulation

OPEN ACCESSMay 14, 2015Organophosphate Poisoning Simulation Maria Sheakley, PhD, Richard Lammers, MD, John Hoyle Jr., MD Maria Sheakley, PhD Ross University Google Scholar More articles by this author , Richard Lammers, MD Western Michigan University School of Medicine Google Scholar More articles by this author , John Hoyle Jr., MD Western Michigan University School of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.10090 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractThis resource is a high-fidelity simulation case on organophosphate poisoning. It follows a 40-year-old adult male with complaints of dimmed vision, watery eyes, shortness of breath, nausea, vomiting, diarrhea, and sweating. The simulation uses a manikin and includes all the necessary materials for learners to complete the scenario. The case is intended to teach teamwork and clinical skills in a realistic emergency department setting, with an underlying emphasis on the physiology of the autonomic nervous system. Students should be able recognize the signs and symptoms of organophosphate poisoning, and select the appropriate personal protective gear for the situation. They should also be able to assign roles to group members, and address the basic airway, breathing, and circulation on the simulated patient. This simulation was used for first-year medical students. The students had a few introductory lectures on the autonomic nervous system and autonomic drugs prior to the simulation event. This was crucial for the students to be able to recognize the autonomic signs and symptoms the simulated patient is exhibiting, and know what to use for treatment. In addition, all of the students had previously completed a Medical First Responders course, which utilized high-fidelity simulators. Due to this training, the students were familiar with basic medical terminology, teamwork as medical professionals, basic first response care, the high-fidelity simulators, and the use of personal protective equipment. Educational Objectives By the end of this module, the learner will be able to: Recognize the symptoms and signs of organophosphate poisoning in a simulated patient.Use medical terminology to describe symptoms and physical findings.Describe the effects of parasympathetic nervous system stimulation by organophosphates as manifested in the following organ systems: cardiovascular, respiratory, visual, gastrointestinal, neurologic, genitourinary, and dermatologic.Explain the pharmacologic mechanisms of atropine and pralidoxime in the treatment of organophosphate poisoning.Demonstrate basic teamwork skills.Recognize hypoxia from clinical signs and/or abnormal pulse oximetry reading.Treat hypoxia with oxygen and assisted bag/mask ventilation as needed.Discuss the importance of patient decontamination and provider protection when caring for patients with organophosphate poisoning. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Organophosphate Poisoning-Resource File and Instructor's Guide.pdf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationSheakley M, Lammers R, Hoyle Jr. J. Organophosphate Poisoning Simulation. MedEdPORTAL. 2015;11:10090. https://doi.org/10.15766/mep_2374-8265.10090 Copyright & Permissions© 2015 Sheakley et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsOrganophosphate PoisoningAtropineSimulationPersonal Protective EquipmentAutonomic Nervous System Disclosures None to report. Funding/Support None to report. tabs.loading

How useful is pulse oximetry for screening of congenital heart disease in newborns?

In the initial pilot study at three hospitals in Shanghai, the authors assessed the accuracy of pulse oximetry plus clinical assessment for detection of congenital heart disease. They then undertook a large, prospective, and multicenter screening study in all consecutive neonates (aged 6–72 h) born at 18 hospitals in China between August 1, 2011, and November 30, 2012. Newborns with positive screen results (either an abnormal pulse oximetry or abnormal clinical assessment) were referred for echocardiography within 24 h of screening. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios for pulse oximetry alone, and in combination with clinical assessment, for detection of major and critical congenital heart disease were calculated.

Analysis of monitoring information about infant congenital heart disease in Changzhou

Screening of CHD of infants (11 178) born from May 1st 2012 to April 30th 2013. 92 infants were screening positive, 68 were diagnosed.The detectable rate of CHD was 6.08‰, while boys were 3.31‰, girls were 2.77‰.68 CHD patients, the top three were VSD(2.14‰), PDA(1.34‰) and ASD(0.89‰). In these infants, detectable cardiac souffle were 61, abnormal pulse oximetry were 40.The detectable rate of CHD among infants was identical compare the average level of whole country, but the distributional characteristics was disparity.The screening of CHD was feasible, and cardiac souffle and pulse oximetry were recommended. Key words: Infants, newborn; Heart defects, congenital