Use Of Pulse Oximetry Research Articles

Oxygen and pulse oximetry in childhood pneumonia: surveys of clinicians and student clinicians in Cambodia

To better understand the availability of oxygen and pulse oximetry, barriers to use, clinician perceptions and practices regarding their role in the management of childhood pneumonia, and the formal education and training regarding these technologies received by student clinicians in Cambodia. In the clinician survey, we surveyed 81 clinicians practising at all national paediatric, provincial and district referral hospitals throughout Cambodia. Respondents were primarily physicians whose scope of practice included paediatrics, and most reported the presence of oxygen (93% (95% confidence interval (CI) [87, 98])) but less availability of pulse oximetry (51% (95% CI [39, 61])). Common barriers to use included a lack of policies and guidelines, as well as a lack of training. In the student clinician survey, 332 graduating medical and nursing students were surveyed, and most reported learning about oxygen (96% (95% CI [94, 98])) and pulse oximetry (72% (95% CI [67, 77])) during their training. Data from both surveys indicate that despite their utility, oxygen and pulse oximetry may be underused in Cambodia. The reported barriers and perceptions of the tools indicate a clear role for improved training for clinicians and students on the use of oxygen and pulse oximetry, the value of oxygen and pulse oximetry for managing childhood pneumonia, and the need for improved policies and guidelines governing their use.

Pulse Oximetry as a Screening Tool to Detect Hypoxia Associated with Early-onset Sepsis in Asymptomatic Newborns: A Feasibility Study in a Low-income Country

Aims: i) To assess the feasibility of using pulse oximetry as a screening tool in lowincome countries to detect hypoxemia associated with early-onset sepsis in asymptomatic newborns. ii) To evaluate the acceptability of pulse oximetry screening to mothers and healthcare professionals. Study Design: Prospective cohort study. Original Research Article British Journal of Medicine & Medical Research, 4(5): 1115-1128, 2014 1116 Place and Duration of Study: Saint Francis Referral Hospital, Ifakara, Tanzania between January and March 2013. Methodology: All eligible asymptomatic newborns of more than 33 weeks gestational age born during the study period were screened on two occasions using pulse oximetry. Newborns with oxygen saturations below predefined thresholds were test positive. We recorded the proportion of eligible newborns screened, time taken for the test and the acceptability of pulse oximetry use to mothers and healthcare professionals. The rates of hypoxaemia and clinical diagnosis of sepsis in asymptomatic newborns were evaluated. Results: A total of 316 asymptomatic newborns were screened, of which eighteen (5.7%) were classified as test positive. Clinical examination led to the diagnosis of sepsis in 41 newborns (13%), including eight newborns who tested positive with pulse oximetry screening. Mothers (n=50) and healthcare professionals (n=18) were predominantly satisfied with screening. Conclusion: It is feasible to evaluate the role of pulse oximetry as a screening tool to detect early-onset sepsis in a low-income setting. The test is acceptable to mothers and healthcare professionals. Further studies are needed to assess the accuracy of the test in detecting sepsis in asymptomatic newborns and its clinical impact on neonatal health.

Myths, fallacies and practical pearls in GI lab.

Many prevalent practices and guidelines related to Gastrointestinal endoscopy and procedural sedation are at odds with the widely available scientific-physiological and clinical outcome data. In many institutions, strict policy of pre-procedural extended fasting is still rigorously enforced, despite no evidence of increased incidence of aspiration after recent oral intake prior to sedation. Supplemental oxygen administration in the setting of GI procedural sedation has been increasingly adopted as reported in the medical journals, despite clear evidence that supplemental oxygen blunts the usefulness of pulse oximetry in timely detection of sedation induced hypoventilation, leading to increased number of adverse cardiopulmonary outcomes. Use of Propofol by Gastroenterologist-Nurse team is erroneously considered dangerous and often prohibited in various institutions, at the same time worldwide reports of remarkable safety and patient satisfaction continue to be published, dating back more than a decade. Of patient monitoring practices that have been advocated to be standard, many merely add cost, not value. Advances in the technology often are not incorporated in a timely manner in guidelines or clinical practices, e.g., Capsule endoscopy or electrocautery during GI procedures do not interfere with proper functioning of the current pacemakers or defibrillators. Orthopedic surgeons have continued to recommend prophylactic antibiotics for joint replacement patients prior to GI procedures, without any evidence of need. These myths are explored for a succint review to prompt a change in clinical practices and institutional policies.

Clinical use of pulse oximetry: Official guidelines from the Thoracic Society of Australia and New Zealand

Pulse oximetry provides a simple, non-invasive approximation of arterial oxygenation in a wide variety of clinical settings including emergency and critical-care medicine, hospital-based and ambulatory care, perioperative monitoring, inpatient and outpatient settings, and for specific diagnostic applications. Pulse oximetry is of utility in perinatal, paediatric, adult and geriatric populations but may require use of age-specific sensors in these groups. It plays a role in the monitoring and treatment of respiratory dysfunction by detecting hypoxaemia and is effective in guiding oxygen therapy in both adult and paediatric populations. Pulse oximetry does not provide information about the adequacy of ventilation or about precise arterial oxygenation, particularly when arterial oxygen levels are very high or very low. Arterial blood gas analysis is the gold standard in these settings. Pulse oximetry may be inaccurate as a marker of oxygenation in the presence of dyshaemoglobinaemias such as carbon monoxide poisoning or methaemoglobinaemia where arterial oxygen saturation values will be overestimated. Technical considerations such as sensor position, signal averaging time and data sampling rates may influence clinical interpretation of pulse oximetry readings.

Strip of the Month: November 2013

Strip of the Month: November 2013

Implementation of a Critical Congenital Heart Disease Pulse Oximetry Screening Program for Newborns

<h2>Poster Presentation</h2><h3>Purpose for the Program</h3> In September 2011, the Secretary of the U.S. Department of Health and Human Services recommended that all U.S. hospitals be required to screen newborns for critical congenital heart disease (CCHD). Screening for CCHD with the use of pulse oximetry also has been endorsed by the American Academy of Pediatrics, the American College of Cardiology Foundation, and the American Heart Association. The purpose of this project was to examine the current research and recommendations supporting the use of pulse oximetry as a method of screening newborns for CCHD and to implement a newborn screening program supported by this evidence. <h3>Proposed Change</h3> To identify and address the implementation steps for initiating a neonatal CCHD pulse oximetry screening program. <h3>Implementation, Outcomes, and Evaluation</h3> A review of recent literature and evidence‐based recommendations supported the need to make screening of every eligible newborn a standard of care in our facility. With the supporting evidence and recommendations in hand an interdisciplinary work group was established to implement a CCHD pulse oximetry screening program for newborns in our facility. Implementation steps identified included the following: (a) policy and procedure development; (b) screening tool and documentation plan; (c) equipment and supply needs; (d) staff training and education; (e) parent education materials; (f) physician notification; (g) community education; and (h) tracking results and follow‐up. Work was initiated and by January 1, 2012 we developed a policy and procedure and a screening form. The physician documentation of screen results was setup in our electronic medical record and equipment was in place. The staff training was completed and educational materials produced. The physicians were notified of the screening procedure and screening for CCHD with pulse oximetry was initiated on all eligible newborns delivered or admitted to UAMS, Medical Center. Ongoing review of the program by the work group continued to assess the need for program revisions as indicated. The policy and screening form were both revised after initial implementation to better address the screening of the ill infant. A plan to track all positive screening results has been initiated within our maternal/infant division to continue the assessment of our screening program, identify any false‐positive results, and assess the medical follow‐up of those infants identified with CCHD. <h3>Implications for Nursing Practice</h3> This project is an excellent example of taking current evidence and research and expanding it into evidence‐based practice at the bedside and the necessity of interdisciplinary collaboration when introducing a new practice into a healthcare facility.

Implementing Capnography in the PACU and Beyond

The potential risk of adverse effects from hypoventilation due to intravenous and/or intrathecal narcotics administration was recognized. SPMHC understood the limitations with the use of pulse oximetry and respiratory assessment in detecting adequate ventilation. Evidence has shown that capnography is the best indicator of respiratory depression.

Neuromuscular monitoring, residual blockade, and reversal: Time for re-evaluation of our clinical practice

Even with the advent of shorter-acting muscle relaxants, the risk of residual blockade continues to persist. Consequently, in daily practice, we are confronted with the following contradiction, namely, how best to combine muscular relaxation throughout the operative procedure without exposing patients to the risk of residual blockade at the end of the case. A Continuing Professional Development (CPD) module concerning residual blockade is published in this issue of the Journal. Why was it necessary to publish a CPD module on this topic when a number of related studies and surveys reports are already available? While many clinicians are convinced about the benefits of both neuromuscular monitoring and reversal in current practice, nevertheless, reality seems to differ. Anesthesiologists are well trained in the use of neuromuscular blocking agents. In fact, anesthesiology is the only specialty where these drugs are routinely used. And yet, many clinicians tend not to follow the basic recommendations for using both neuromuscular monitoring and reversal agents. The circumstances leading to this state of affairs are likely more complex. The last updated version of the American Society of Anesthesiologists’ (ASA) Practice Guidelines for Postanesthetic Care states that: ‘‘Assessment of neuromuscular function primarily includes physical examination and, on occasion, may include neuromuscular blockade monitoring’’. With such an assertion regarding the potential for occasional use of neuromuscular monitoring, it would, in all likelihood, be difficult to convince our colleagues regarding the benefits of neuromuscular monitoring and modify existing behaviour. Clinical methods for determining signs of residual blockade may not have the degree of sensitivity to detect partial paralysis. For example, residual paralysis is likely in patients who are able to maintain a sustained head lift. It is only with objective neuromuscular monitoring that one can exclude residual blockade. Clearly, the ASA Task Force on Postanesthetic Care developed their recommendation based on data lacking in sufficient evidence. This is also the basis for SpO2 monitoring. Pedersen et al. from the Cochrane Collaboration updated the systematic review on the use of pulse oximetry during the perioperative period. The authors’ conclusions are comparable with two previous reviews published by the same group. Even if the use of pulse oximetry helped decrease the frequency of hypoxemic episodes, it does not influence patient outcome on major end points (e.g., death and cardiovascular, respiratory, or neurological complications). Even when we consider these evidence-based data on pulse oximetry, can any one of us imagine starting a case without its use? This depiction reveals the limits of evidence-based medicine. This topic has previously been addressed with humour in a study on whether or not there are benefits to using a parachute to prevent death during free fall. Residual blockade remains a specific concern in daily anesthesia practice. The use of neuromuscular blocking drugs has facilitated major progress in performing additional and more complex surgical procedures. This view was first addressed by Dr. Harrold Griffith et al. 70 years ago when Benoit Plaud is consultant for MSD France and MSD International and has participated in the clinical development of sugammadex (Bridion ).

Cardiac Arrest 2012

Cardiac Arrest 2012

Management of Asymptomatic Cardiac Murmurs in Term Neonates

Approximately 2 % of newborn infants are noted to have cardiac murmur on routine postnatal examination. Our aim was to look at current evidence and practice in the management of asymptomatic cardiac murmur in term neonates. We performed a systematic literature review and a telephone survey of all neonatal units in the United Kingdom (UK). The systematic review of the literature did not support the routine practice of four-limb blood pressure (BP), chest X-ray (CXR), and electrocardiogram (ECG) in the assessment of asymptomatic cardiac murmur in term neonates. The survey had participation from 132 (68 %) of 193 neonatal units in the UK. In an asymptomatic term neonate with cardiac murmur, 124 (94 %) units perform pulse oximetry, 100 units (76 %) measure four-limb BP, 36 units (27 %) perform a CXR, and 52 units (39 %) perform an ECG. Eight-six units (65 %) have availability of in-house echocardiography services provided mainly by paediatricians with cardiology interest in special care units and neonatologists in neonatal intensive care units. Currently there is wide variation in practice in the management of asymptomatic cardiac murmur in term neonates. There is no evidence to support the routine use of four-limb BP, CXR, and ECG in the assessment of asymptomatic cardiac murmur in term neonates. Based on the evidence available, both structured clinical examination (including determining presence and quality of bilateral femoral pulses) and universal use of pulse oximetry are most important in identifying CHD in asymptomatic term neonates with cardiac murmur before discharge home.

Seizures and Methemoglobinemia in an Infant After Excessive EMLA Application

Topical anesthetics are commonly used in many health care settings and for many clinical conditions. However, there are a number of potential adverse effects associated with their use. Their widespread administration can convey a false sense of security and failure to appreciate possible complications. We present the case of an infant with extensive vascular malformations treated with EMLA cream who developed seizures and methemoglobinemia from lidocaine and prilocaine toxicity. We describe the pathophysiology of these morbidities, the use of pulse oximetry in this setting, and the clinical presentation and treatment of methemoglobinemia.

Utilidad de la pulsioximetría en el cribado de enfermedad arterial periférica en pacientes ingresados en servicios de medicina interna

IntroductionAnkle-brachial index measured by a continuous wave Doppler device remains as the reference method for office diagnosis of peripheral arterial disease. This method is time consuming, requires an appropriate device and training of the examiner. We evaluated the usefulness of pulse oximetry as an easier method to screen for peripheral arterial disease. MethodsA total of 110 subjects were selected by opportunistic sampling among patients admitted to a general medicine service. Entry criteria were age older than 50years and having an additional cardiovascular risk factor. Patients with known cardiovascular disease were excluded. We measured oxygen saturation (SaO2) by means of a pocket finger tip pulse oximeter at 4limbs. SaO2 was measured at right and left index fingers and great toes with patient lying and after elevating the foot 30cm above the bed. We considered as abnormal a difference in SaO2 greater than 2% between fingers and toes. Brachial index was estimated by means of a handheld Doppler device. ResultsThe prevalence of peripheral arterial disease was 10% (95% confidence interval [CI], 6%-14%). Pulse oximetry has sensitivity 12% (95%CI, 4%-37%), specificity 67% (95%CI, 60%-74%), positive likelihood ratio 0.43 (95%CI, 0.11-1.19), negative likelihood ratio 1.27 (95%CI, 0.91-1.45) and area under the receiving operating characteristics curve 0.75 (95%CI, 0.67-0.82). ConclusionsPulse oximetry showed low accuracy as screening method for peripheral arterial disease. Simpler and more accurate devices than ankle-brachial index measured by Doppler are necessary to ease the screening of peripheral arterial disease.

Nursing surveillance moderates the relationship between staffing levels and pediatric postoperative serious adverse events: A nested case–control study

BackgroundInsufficient monitoring, surveillance, and nurse staffing levels are system factors that may contribute to serious adverse events and deterioration in hospitalized patients. Limited data have examined the relationship between these factors and postoperative outcomes, particularly in the pediatric setting. ObjectivesThis retrospective, case–control study examined the relationship between surveillance, staffing, and serious adverse events in children on general care postoperative units. The following hypotheses were tested: (1) the relationship between patient factors and surveillance would be moderated by staffing (i.e., registered nurse hours per patient per shift), and (2) the relationship between staffing and serious adverse events would be mediated by surveillance. MethodsWith institutional review board approval, children with serious adverse events on a general care unit were identified from institutional event databases, and procedure-matched controls were randomly selected from surgical lists. Demographics, co-morbidities, perioperative information, frequency of postoperative monitoring and assessments (i.e., surveillance), and registered nurse hours per patient per shift (i.e., staffing) were recorded. Regression models were used to test the hypotheses. ResultsThe Event Group included 98 children and the Control Group, 158. Registered nurse hours per patient per shift were lower for the Event Group (2.99±0.59) compared to Controls (3.38±1.23, p=0.002). The number of assessments/shift was higher for the Event Group (4.27±2.8) compared to Controls (2.85±1.9; p<0.001), as was use of continuous pulse oximetry (78% vs. 58%, respectively; p=0.001). Staffing moderated the relationship between comorbidity and surveillance (r2=0.192, p<0.001) revealing a significant relationship at lower staffing but not higher. Surveillance did not mediate the relationship between staffing and events, but moderated it (r2=0.435; p<0.001) showing no relationship at lower surveillance levels. ConclusionsNurse staffing levels moderated the relationship between patient factors and surveillance demonstrating that this association is dependent on staffing levels. The association between staffing and adverse outcomes was dependent on the level of surveillance. Increased surveillance based on recognition of deterioration may have facilitated rescue of children in this setting, even during times of lower staffing.

The use of overnight pulse oximetry and phoniatrics parameters in the screening protocol of obstructive sleep apnea

BackgroundObstructive sleep apnea–hypopnea syndrome (OSAHS) is a major public health problem due to its high prevalence rate. Polysomnography is the current golden standard test for diagnosis of OSAHS. The studies with pulse oximetry reveal a high sensitivity and suggest that as a screening tool, these may exclude some patients with negative studies from further work-up for OSAHS. Acoustic analysis of snoring sounds would offer the advantage of a non-invasive technique that would be used to monitor normal sleep. The posterior vocal tract resonances (i.e. F1 and F2) of OSA patients would yield lower frequency values compared to non-OSA individuals. ObjectiveTo determine the sensitivity and specificity of overnight oximetry and phoniatrics parameters in evaluation of OSAHS and to compare the results with those obtained from polysomnography (PSG) as the gold standard test. Patients and methodsTwenty patients, were presented with presumptive clinical diagnosis of OSAHS, each patient was subjected to: Full history taking: including age, sex, complain and Epworth Sleepiness Scale (ESS). Systemic examination: Including general examination and body mass index (BMI). Standard ENT examination and fibroptic pharyngoscopy with Müller maneuver. Polysomnography was done using RESMED Apnea Link screening device. Other tests: Acoustic analysis of voice and acoustic analysis of snoring sounds using computerized speech lab (CSL). Pulse oximetry: The overnight oximetry was analyzed using the Wrist Pulse Oximeter MD300W. ResultsEighteen patients (90%) were found to have OSAHS and two patients (10%) were simple snorers. The sensitivity of overnight pulse oximetry for an apnea hypopnea index of >5, >15, and >30/h was 66.7%, 80%, and 100% respectively and the specificity was 50%. The formant frequencies of different vowels (i, u and a) in OSA patients and non-OSA snorers revealed that the mean F1 value for the vowel /i/ was significantly lowered in OSA patients. In addition, the mean F2 value of the vowel /i/ and /u/ was markedly lowered in OSA patients. There was significant increase in values of bandwidths (BW1 and BW2) for /i/ and /u/ vowels in OSA patients in comparison to non-OSA snorers.Acoustic analysis of snoring sounds revealed that; in the palatal snorers group, the average pitch was 105±8Hz and in the tongue base snorers group the average pitch was 263±17Hz; meanwhile the average pitch in the combined group was 160±14Hz. The difference was highly significant between the 3 groups. However harmonic to noise ratio was increased in patients with tongue base obstruction. ConclusionsPolysomnography is the current golden standard test for diagnosis and evaluation of degree of OSA. Overnight pulse oximetry offers an inexpensive method of screening for and diagnosing OSAHS. Oximetry alone allowed confident recognition of moderate and severe cases of OSAHS. Acoustic analysis of snoring sounds and voice in patients with snoring and/or OSAHS is useful as a screening or supportive method with other investigations to diagnose the site of upper airway obstruction during sleep.

Turn and face the strange – ch..ch..ch..changes to neonatal resuscitation guidelines in the past decade

Resuscitation of newborns has been described since ancient times and is among the most commonly performed emergency medical interventions. The International Liaison Committee on Resuscitation first made recommendations on resuscitation in newborns in 1999. Over the last decade, new research and careful review of the available evidence have resulted in substantial changes to these recommendations - in particular, regarding the assessment of colour, giving supplemental oxygen, suctioning infants born through meconium-stained liquor, confirming endotracheal tube position, the use of pulse oximetry, giving CPAP to premature infants, keeping preterm infants warm using polyethylene wrapping and cooling term infants with encephalopathy. This process has also highlighted the paucity of evidence to support much of the care given to infants in the delivery room and the need for research to refine our techniques.

Usability testing of a prototype Phone Oximeter with healthcare providers in high‐ and low‐medical resource environments*

To increase the use of pulse oximetry by capitalise on the wide availability of mobile phones, we have designed, developed and evaluated a prototype pulse oximeter interfaced to a mobile phone. Usability of this Phone Oximeter was tested as part of a rapid prototyping process. Phase 1 of the study (20 subjects) was performed in Canada. Users performed 23 tasks, while thinking aloud. Time for completion of tasks and analysis of user response to a mobile phone usability questionnaire were used to evaluate usability. Five interface improvements were made to the prototype before evaluation in Phase 2 (15 subjects) in Uganda. The lack of previous pulse oximetry experience and mobile phone use increased median (IQR [range]) time taken to perform tasks from 219 (160-247 [118-274]) s in Phase 1 to 228 (151-501 [111-2661]) s in Phase 2. User feedback was positive and overall usability high (Phase 1--82%, Phase 2--78%).

Use of Pulse Oximetry in the Delivery Room

Please read the following vignette and watch the video clip (Fig 1).A 40–2/7-weeks’ gestation infant is delivered through clear amniotic fluid after an uncomplicated pregnancy. Immediately after birth, the infant is nonvigorous. The infant is warmed, dried, and stimulated, and the airway is opened. At 30 seconds after birth, the infant has no respiratory effort, and the provider begins positive pressure ventilation (PPV). Which of the following are indications for the use of pulse oximetry?Correct ResponseE. Persistent central cyanosis.PPV is required for more than a few breaths.Resuscitation is anticipated.Supplemental oxygen is administered.An oximeter should be used to confirm the perception of cyanosis, when PPV is required for more than a few breaths, whenever resuscitation is anticipated, and when supplemental oxygen is administered. Immediately after birth, the team must determine whether the infant is breathing or crying and has good tone. In this vignette, the infant was nonvigorous; therefore, she required the initial steps of the Neonatal Resuscitation Program algorithm (Fig 2), which include the following:Once PPV is initiated, the team should place a pulse oximeter on the infant’s right wrist or hand. Resuscitation of the term infant ought to begin with room air (21% oxygen). Every delivery room should have the ability to provide blended oxygen and pulse oximetry during resuscitation. Oxygen concentration is adjusted to achieve age-specific preductal (right hand or wrist) oxygen saturation (Spo2) targets as determined by using pulse oximetry.To permit the most rapid acquisition of signal, the probe should be attached to the infant before it is connected to the instrument. Most instruments will not provide a reliable reading of saturation until a pulse is detected.Pulse oximetry measures Spo2 continuously and noninvasively, correlating closely with arterial oxygen saturation. Pulse oximetry measures the red and infrared light absorption characteristics of oxygenated and deoxygenated hemoglobin as the blood flows through the capillaries of the skin. A sensor is placed around a hand or wrist and two light-emitting diodes send red and infrared light through to a photodetector on the other side. The changes in absorption during the arterial pulsatile flow and nonpulsatile component of the signal are analyzed. Oxygen saturation is estimated from the transmission of light through the pulsatile tissue bed. With each heartbeat, there is a surge of arterial blood that momentarily increases arterial blood volume; the result is more light absorption during surges. Because peaks occur with each heartbeat, heart rate can also be measured.In summary, use pulse oximetry:Efforts must be taken to optimize teamwork during crisis situations that occur during neonatal resuscitation. For a team to work together, there needs to be a shared mental model; this is achieved through effective communication. Prioritization is an important behavioral skill when managing critical situations; 30 seconds after birth in a nonvigorous infant, the priority is determination of heart rate and respiratory effort. At this stage (by 30 seconds), the nurse should be listening and/or feeling for a heartbeat and stating the rate out loud. It is critical that such interventions be stated verbally to establish a shared mental model, one of the principles of effective communication. Creating a shared mental model allows all members of the team to focus on the next intervention; pulse oximetry can be exceedingly helpful to a team in these moments of chaos. Auscultating a heart rate is often difficult when the room is noisy or when the rate is slow and the patient is receiving PPV; pulse oximetry provides an objective measure of heart rate for the entire team to see. This measurement drives intervention and allows everyone to operate from the same understanding of patient condition. In this case, once the pulse oximeter is detecting a pulse (usually 30–60 seconds after the probe is placed), someone on the team should state the heart rate out loud to allocate attention to improving ventilation. Successful allocation of attention requires that one be cognizant of the details while adequately assessing the patient’s overall needs. This attention results in effective prioritization; when the heart rate is low, the first priority is to improve ventilation.

Change in Oxygen Saturation Does Not Predict Acute Mountain Sickness on Jade Mountain

The purpose of this trial was to establish whether changes in resting oxygen saturation (Spo(2)) during ascent of Jade Mountain is useful in predicting acute mountain sickness (AMS). AMS-risk factors were also assessed. A prospective trial was conducted on Jade Mountain, Taiwan from October 18 to October 27, 2008. Resting oxygen saturation (Spo(2)) and heart rate (HR) were measured in subjects at the trail entrance (2610 m), on arrival at Paiyun Lodge (3402 m) on day 1, and at Paiyun Lodge after reaching the summit (3952 m) the next day (day 2). AMS was diagnosed with Lake Louise criteria (AMS score ≥4). A total of 787 subjects were eligible for analysis; 286 (32.2%) met the criteria for AMS. Subjects who developed AMS had significantly lower Spo(2) than those who did not at the trail entrance (93.1% ± 2.1% vs 93.5% ± 2.3%; P = .023), on arrival at Paiyun Lodge on day 1 (86.2% ± 4.7% vs 87.6% ± 4.3%; P < .001), and on the return back to the Paiyun Lodge after a summit attempt on day 2 (85.5% ± 3.5% vs 89.6% ± 3.2%; P < .001), respectively. Trekkers with AMS were significantly younger (40.0 vs 43.2 years; P < .001), and had less high altitude (>3000 m) travel in the previous 3 months (29.9% vs 37.1%; P = .004). Subjects with AMS had a lower Spo(2) than those without AMS; however, the differences between the 2 groups were not clinically significant. The results of this study do not support the use of pulse oximetry in predicting AMS on Jade Mountain.

Educating the Educator: Use of Pulse Oximetry in Athletic Training

The 5th edition of the Training Education Competencies expanded the scope of knowledge and skill set of entry-level athletic trainers related to the domain of Acute Care of Injuries and Illnesses. One of these major changes includes the introduction of adjunct airway techniques, such as oropharyngeal and nasopharyngeal airways and suction. Another new addition includes the use of pulse oximetry to assess oxygen saturation levels. The addition of these acute care knowledge and skill competencies were incorporated into the athletic training curriculum to reflect the National Athletic Trainers' Association's currently published position statement recommendations, as well as those in development. This article provides athletic training educators (ATE) with a resource on how to use and teach pulse oximetry within their educational programs. (Contains 7 tables and 1 figure.) Language: en

A Survey of Procedural Sedation and Analgesia Practices in Pediatric Oncology Centers in India

Repeated lumbar punctures (LP) and bone marrow aspirations (BMA) are part of childhood cancer management. Adequate sedation and analgesia for these procedures in a safe environment is desirable. We evaluate current practice related to this in pediatric oncology centers in India. Clinicians attending the 2nd Annual India Pediatric Oncology Initiative meeting at New Delhi in February 2010 were invited to complete a questionnaire. Questionnaires were also sent by email to the remaining major pediatric oncology centers not represented at the meeting. Responses for LP and BMA were separately collated and variability by type of hospital and patient caseload was assessed. Responses were obtained from 26 of 32 centers (81%) approached. A median of 3 personnel (mostly pediatric residents and nurses) were present during the procedures. Some form of sedation and analgesia was used for LP and BMA in 88.5% and 100% centers respectively. However, use of systemic sedation and analgesia (usually midazolam +/- ketamine) for LP and BMA in ≥75% patients was seen in 47.8% and 61.6% centers respectively. General anesthesia was not used in any center. Additional restraint was commonly used and its use was significantly more in public hospitals (p = 0.01). Monitoring was usually done by observation of vital signs, with use of pulse-oximetry in less than half of the centers. There is varied use of sedation and analgesia for LP and BMA in pediatric oncology centers in India. Further research is needed to identify the reasons for this. Availability of resources is likely to be a factor.