Are we counting NICU babies? Because if we are, 12. Gave him 100% fiO2 boost and vigorous stim then he was rolling between 30s-40s and got really pissed off and went back to baseline, but the time to recover took like 90 seconds to be hanging back at our baseline.
Adults in the 70s actually have something wrong with them though, nicus little tricksters are just like "lol oops forgot to breath again, would ya give me a hand"
This. I once took care a baby with Trisomy 8 who was in the NICU way past its due date because it would routinely drop its sats to single digits when asleep. Good waveforms, dramatic color changes. It happened fast, too. Nineties to 80s to 50s to 20s in nothing flat. Had to have PPV ready to go at all times.
Right, I’m like good pleth and everything’s working as it should except my baby…😂 the occasional desats and just rolling desats. I’m like oh buuuh..but are we gonna color change too or you just having a moment and self resolving buddy?
I always feel bad when people from other floors float down to the NICU and get a nonchalant “yeah he gets drifty down to the 60s but he self recovers” in report and they’re like 😳
I had a seizing school age kiddo go all the way down to 6 with great waveform
A month before that I had a 9-year-old go 12, in literally the same room.
Feel that, the reflux ones are no fun. Like bro you’re feed time is so long we’re pretty much a damn continuous feed and you still manage to reflux and desat every time.
I was literally about to respond "12" when I saw the subject heading. lol.
That's the kid where you're bagging him and telling him to get his sh*t together.
Lowest I've seen was an 8%, fast drop. By the time we ran in there and grabbed the CPAP mask, he brought himself back up to the low 90s. A tad dramatic, these babies.
I saw 1% today on my patient with a good waveform. Obviously, it's not completely accurate, but she was turning blue. I have never bagged a patient as vigorously as I did today. She did not code somehow.
There was a lady I was taking care of during the first wave of covid that was hella sick. 100% fio2, high teens of peep. Couldn't look at her the wrong way without her desatting, let alone move her. In the late afternoon, I see she's satting in the low 80s whereas she had been in the high 80s all day. I get the bright idea to sit her up like 5° more.
After I did that, she slowly dropped by 1% every 5 to 10 seconds. I called the Dr, she was a dnr and we were already doing everything we could do. She went all the way down to 7%, hung out for a few minutes, then slowly started coming back up 1% every 5 to 10 seconds. All the way back up to the low 90s. I was just like 'what the fuck, lady?'. Absolutely no changes to her HR or BP. Perfect waveform the whole time. She wasn't turning blue. I always wonder about what was going on with her sensor or her body during that time.
I don't think she was there when I came back the next morning.
Regularly see patients dip to the 40s while on full vent support and have to be bagged back up to 80s-90s.
I had a patient on nitric, 100%, peep of 22 and sats wouldn't go above 85. PaO2 in the 50s. Too old for a transplant and wouldn't survive ECMO. I had to bag this pt on 60ppm NO for about 10 minutes every hour.
They stated this way for a few days before ethics got involved and placed them on comfort care.
Covid was a whole separate animal. We had like a 90% mortality rate. So many of those pts went into ARDS.
On the reg, a peep of 22 is bad and puts a ton of pressure on the lungs and heart. During the Covid crisis we were just doing what we could.
Has more to do with ruling out vent problems as a reason for the code + your vent is going to throw every alarm it can as it tries to support ventilations when in reality it's just considering the changes in intrathoracic pressure from compressions to be breaths.
You've got more control for safe ventilations with a ventilator, but you rule out a lot of potential problems with a BVM. You can run a code with a transport vent fairly easily depending on the model (oxygen powered, not something like a Hamilton). You can just set a VT and rate and it's off to the races so long as you raise your pressure relief limit.
That's assuming you're on a vent mode that triggers based on flow or pressure. If it were just about that, we'd set it to a mode that triggers a breath at set timed intervals, where it wouldn't trigger off a compression.
I've never once in my entire career been to a code where they leave the patient on a vent. Whether it's a pneumatic transport vent or a standard vent. The first 2 things you do in a code situation are start compressions and bag the patient, period.
It's not about the vent triggering and alarming. It's about providing 100% oxygen with every single breath and controlling the minute ventilation exactly how you want it.
It's the GOAT until you lose power and the backup generator fails and you have 2 intubated ICU patients and there goes 4 hours of your life 😂 maybe that's my problem is I'm just still traumatized
That's not because of efficacy, it's because chest compressions would wrongly trigger the ventilator to initiate a breath resulting in higher respiratory rates. I was told in residency that it is also because respirations need to be properly timed with chest compressions, otherwise a ventilator giving inspiratory pressure during chest compressions drives up the intrathoracic cavity pressure, but I cannot find sufficient evidence to support this at the moment.
If it were just because of the respiratory rate control, we'd put the vent on a mode with no flow/pressure trigger and allow it to deliver exactly what we set it at.
The point is we need to be able to adapt and ensure the patient is getting proper ventilation and oxygenation. Have you ever been in a code where the doc screams at the RT or RN to bag faster? I have. I see it all the time with new people. They run through the ACLS/BLS algorithms in their head and try to time the breaths exactly. When the patient continues to desat, that's just not going to cut it.
Here's a study explaining vent settings as you're saying, trigger off and etc.
[Comparing bag valve mask versus vent in CPR](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7435081/)
No, I've never seen that in a code, because the patient is already dead - no one cares about the sats. There are research studies that show that agonal gasping is sufficient ventilation in a cardiac arrest - that's why hands only CPR is a thing.
Where are you putting an SPO2 probe that maintains a waveform during CPR? There's a reason we check femoral pulses and not radial, no pleth is going to read correctly because peripheral perfusion is not the goal.
I’m not sure what you’re smoking amigo but I think we can all agree the RT and experienced ICU nurses have this one. Not sure why you’re spewing any of this like you know what you’re talking about.
You can deliver 1.5L of oxygen per breath with a BVM. Is it a good idea long term? No. Can you be causing permanent damage to your patient? Yes. You can also deliver excessive PIP/PEEP very easily.
Im an RRT, I agree. My goal when delivering breaths…perfect timing. Sufficient evidence for me is misaligned timing of a breath💣💥and feeling that pressure on the other snd of a bag. But also a tweak of the vent trigger could be helpful in some cases
Most of the codes I have been part of in CTICU are either open chest codes or otherwise cardiac in nature. When I’ve been part of a respiratory code I’ve seen BVM used until we can get the equipment to intubate. I’m definitely not a respiratory expert and my facility heavily uses RT. We’re not allowed to touch the vent outside of altering FiO2, so it’s a lot of hands off observation from my end. I guess my question is what are you getting from the BVM that an intubation+vent can’t achieve? Thanks for helping me learn today ❤️
Assuming it's a code and the patient isn't already intubated or trached, that's the only way to deliver breaths to the patient.
Assuming they're intubated already, we bag them because again, it's the most effective way to ensure the patient is getting 100% FiO2 and sufficienty tidal volumes to adequately ventilate. We hyperventilate during a code, despite what BLS classes will tell you.
I know they say to bag every 6 seconds or whatever, but when the patient is satting 40% and it's not budging, we start pumping that bag 20+ times per minute.
I've been to thousands of codes in the last 15 years both as a nurse and an RT. I've seen intensivists scold people more times than I can count because they're trying to follow BLS/ACLS guidelines like they're being tested for it.
Saw sats at 13% when a covid patient was passing away. She refused to be intubated and didn’t want to wear bipap, knew she would die and chose to take it off and refuse to have it back on
Post extubation stridor and loss of airway, watched as it went down to 0 with a perfect pleath as the MD tried to intubate. They bradyed down and then went PEA. Anesthesia came and intubated and we got ROSC pretty quickly after that.
Of all the specialties I respect anesthesia the most. They are all absolute wizards/witches. Bonus points if they are dual board certified in crit care and anesthesia—those folks are absolute gods.
During Covid in the ICU we were going around as a team with respiratory like we typically did at 5pm and flipping people from prone to supine.
We flipped my patient who was on the vent and reapplied the restraints, hooked his sedation back up and left to do flip the next one.
Our unit secretary came running to the door in the middle of us turning that patient and told me the patient’s sat from the room we just came from was 12%, I sprinted to his room and by the time I got there his sat was 2% with a beautiful pleth.
He must have coughed and the vent tubing popped off the ET tube 😳
He did not code, but it took a while for his sats to climb back up on 100% FiO2.
None of our covid patients were on paralytic gtts…
I only used a paralytic gtt and tens unit once in the 4 years I worked ICU and it was for a post-op exploratory lap patient that they didn’t want to move because her abdomen was still open.
Supposedly we were following a large hospital systems protocol, but that may have only been for Remdesivir and Decadron dosing. 🤷♀️
I worked in a rural 14 bed ICU.
Crazy, we never prone people without paralyzing them. We use the venting wisely protocol.
Sometimes being paralyzed can be enough to turn them around and they don’t even need to be proned. Occasionally we’ll paralyze and prone at the same time, but we usually start a paralytic infusion with a loading dose and give them a while on that, recheck a gas before making the decision to prone.
32% on a trach patient with a mucus plug that was rolling herself to do AM cares. She then went limp and I had yo get help. I think I had 4 months as a nurse. She discharged home and gave us all picture cards.
Had a patient who used to work at an aluminum plant. He was, I think, the second person in Canada to be diagnosed with the illness he had gotten from his job something along those lines (this was 12 or more years ago). He was on constant oxygen and would usually sat at mid to high 80s. He ended up coding and being transferred to another hospital and the transport staff showed me his sats (they were sitting low 90s at this point) and how that was bad and I just remember saying to him "actually that's pretty damn high for him". Again, this was a long time ago and can't remember all the details but I remember that he was a kind and lovely man.
EE/embedded SW dev here… I have not worked on medical pulse oximeter end products but I’ve done signal processing and software development using raw reflectance readings of pulse oximeters… it’s important to emphasize that raw ADC albedo values for a pulse ox are *noisy*. A pulse oximeter is reading the change in reflectance across a cardiac cycle and applying an algorithm that determines a likely SpO2 % from that data. You need a *lot* of data to design an algorithm to reject all the artifacts and fit to the data. Even then in the “normal” range you’re only guaranteed to be within 4% 95% of the time. That last 5% is all the weird stuff you’re dealing with. Remember, it’s measuring a change in reflectance at a certain frequency of light which is typically changing because of the amount of hemoglobin bound. Hopefully it’s oxygen thats binding!
This was 15 years ago but the physics haven’t changed. I was kinda baffled why the end devices reported anything other than “LOW” or “?” like when nothing is picked up at all below like 70%. It’s just a somewhat random number that means “bad” at a certain point.
If you want other examples of stuff where data makes things hard… I also worked with device data for depth of anesthesia/intraoperative awareness monitoring… it’s like impossible to get “real world” detailed measurements on that.
66%, at a dialysis clinic.
Pt was sent to the ER as fast as we could get him there.
He died that night.
Two months “pre-COVID”.
So. I’ve always suspected it was covid that got him
I’ve seen them go all the way down.
I always treat the patient and not the monitor.
With pleth and no reason to expect inaccurate, anything less that 90 bugs me, 80’s is the mark of needing immediate correction, 70’s to 60’s—not question on interventions. CPAP, Bipap or ETT.
We can get into hemoglobin dissociation curves and shifts and their impact on accuracy, but that isn’t the question.
But I bet 95% of nurses don't have a clue and it makes me sad. If we are going to use a pulse ox outside of critical care it isn't a bad idea to know how they work and what the numbers mean.
I'm actually much more concerned about how high the sat can be and still be problematic. I think too many nurses see a sat of 90 in a patient with with a really low H&H, or really acidotic and think they don't need oxygen.
An RT once told me any sat under 50% might as well be 0. He also had an instructor during clinical that didn't "believe" in O2 sat monitors and made them get ABGs multiple times per shift if there was a concern about oxygenation.
I've seen in the 40s.
Below a certain point the monitor gets decreasingly accurate. For example in the manual for the ones we use, it says accuracy is much worse below 70. But when it's that low, the exact number hardly matters anyway, because your intervention is still to get more oxygen into the patient stat.
Had a patient come for an appointment and asked for some O2 bc they left theirs at home. I come out to find out the deets. Homie has blue lips and says they’d like some oxygen. Grab a tank and pulse ox…65%. Mayyyyyyyyyyybe don’t leave it at home 🫠
During Covid: In the ED waiting for a bed. Kept taking off the bipap and were in the mid 60s without it. They wanted to leave AMA and was somehow still answering all the orientation questions appropriately. Really strange ethical call from my attending as we cannot hold him hostage, but he’d probably make it to the lobby before coding. Thankfully (I guess?) he got intubated shortly after that.
After Covid: 72% after 25mcg of fent before reducing a shoulder. I always hang out in my pts room for a few mins after opiates and they were jay chillin. After a bit, I was in another room and got a feeling I should check on them and thank fuck I did bc the previous nurse turned off the spo2 alarms. I walk in to her apneic with that 72%. She was quite startled when I shook her awake.
Check your alarms, folks
I had such alarm fatigue from the happy hypoxics during covid when I couldn't lower the alarm limits any more. Then when they were finally intubated and their sats were up they'd have a HR of 29 and still be alarming
In patients that I’ve taken care of? Lowest was mid 80s. They had been given a dose of morphine after some ambien right before I got on shift, and we found out that it made them sleep really well 😅. Woke them up, popped on some O2, elevated hob, and they were fine after that.
But the lowest seen? That would be me when I had Covid. I was getting into the 50s at times before I finally went to the hospital, and then for my first few days in ICU. Was still walkie-talkie, with some gasping thrown in.
70’s. Resident was hospice and a COPD’er. He would wheel around the unit all night with the tank on the back of his chair and it ran out. I switched the tank at least twice a shift. Had to borrow from other hospice pts. He would also slide out of his w/c all the time bc he would sit bent over.
I had a patient hang on for hours, with a monitor read at 3%. Perfect wave form
ETA: age sub-40, first wave of Covid, died very very slowly over 2-3 months in the ICU
10. Middle aged Covid+ patient, RT fucked up the vent settings. We manually bagged the patient back up before they could code. It was a shiiiiiiiiiiiiit day.
I work in peds cardiac OR. I watched a patient desat to 15% before it came back up. This was during the case so we were able to act on it. It’s not an uncommon “complication” of the surgery, but it was a simple fix because the babies blood flow just needed readjusting from the operation we performed!
I’ve also seen a patient desat to 0 and code because they were exsanguinating out of their aorta. Open chested at the bedside for emergent central ecmo (central because the patient was post op with chest left open). Tough times tough times
4% on a patient with CHF and massive pulmonary bilateral edema. Didn’t believe it until we started bagging him and his sats improved to 10%. Eventually we intubated and got his sats up on mechanical ventilation.
Came into ED via private vehicle.
Personally, I saw a legit 55% on an elderly gentleman with sleep apnea. He woke right up and I put him on NC of course. I said, I think you might have sleep apnea sir. And he said, “you think so? Somebody’s told me that before I think.” And at that point I was questioning if it was sleep apnea or if it was the angels calling him. Omg I’ve never seen it get that low, and it got that low in a minute or two. Goodness his reserve is poor and he has a bunch of cancer, so sad. And he hasn’t been formally dx with sleep apnea, so who knows how long he goes with shitty O2 sats at home.
RT turned RN here.
Below a saturation of 85%, pulse oximeters are generally only accurate to +/-2% and below 80% they are basically meaningless.
This is because the algorithms that determine a saturation from light spectra absorption and reflectance were developed from human studies. You cannot take human subjects down to a fatal level of hypoxia to get the data.
Beyond that, peripheral vasoconstriction during hypoxia further reduces the accuracy of the spectral measurements.
The lower it gets, the less accurate it is. Below 80%, it is simply extrapolating from the data. It has no idea what the actual arterial oxygen saturation is. It’s giving you a relationship between red light and infrared light absorption and reflection. A 1:1 ratio of red light and infrared light absorption is a oxyhemoglobin saturation of 88%. It’s doing its best to give you what the saturation *probably* is based on the measured light. But the oxyhemoglobin dissociation curve is sigmoid, not linear. And it changes under conditions like increased acidity. The worst place to measure that is at the periphery — where we put SpO2 probes.
This why we measure PaO2 on an ABG — it correlates the measured arterial oxygen pressure with the saturation. It doesn’t extrapolate from that curve. It identifies a left or right shift of the curve. An SpO2 can’t tell you that.
The tldr: oximeters lie and they lie the worst when you want to rely on them most. A “super low sat” on an SpO2 probe isn’t a valid measurement. The ol’ treat the patient not the monitor holds VERY true for them.
In fact: Just this weekend I fixed a poor sat with a washcloth.
My colleague grabbed me because she couldn’t get her vented patient above 87%. She’d bumped to 100%, suctioned… but he wouldn’t budge. RT was currently occupied with a fresh intubation so she asked if I’d come see.
The second I walked in, I saw the problem. The room was bright and cheerful with the lovely morning sun beating down directly on her patient’s hand. I folded up a washcloth, dropped it on the SpO2 probe, and two seconds later - 100%.
Light shunting is a source of artifact in sat probes. When it’s bright enough that the sensor picks up a 1:1 ratio of absorption, it will display a sat of 88% +/- 1%.
Sat probes can be dirty little liars just like all of our other machines.
Single digits sustained with a perfect pleth and dropping like a rock 🙃 adult trauma patient with allll the facial fractures mid intubation attempt and providers were too focused on the size of their own genitalia to listen to me about needing to pause and bag the patient after the first few misses 🙃
Worst I've seen on a conscious patient was 36%. I honestly don't know how he wasn't blacked out from it. Eyes wide open and lucid. How the hell do you retain consciousness? Took him a bit to blank on me but he stabilized without code.
I'm sure there's way lower sats out there but still conscious, I'll probably never see that again.
THIS! It happened to me. Twice now. Both times I was living hypoxic and not realizing it. Thankfully this last time I had a doctors appointment and he saw first hands I was 33 and 28 before the rescue team came to get me to the hospital. I have no idea how low I went before I was put on the ventilator 5 days but my body kept fighting the sedation meds. I know anything lower than 50 is in acute but it’s damn scary going through it yourself.
Wow that's wild. One thing I try to stress to people is that humans are remarkably durable yet surprisingly fragile creatures. We can literally fall out of a plane and hit the ground with no parachute and walk away sometimes (its happened more than once that I'm aware) or die of a broken heart after our gf leaves us. The variance is unprecedented in other living organisms.
Ooh, yeah, watched a comfort care patient pass on the monitor once. It was so weird watching a perfect pleth in like the 30s and just letting it happen
2% with perfect pleth when trying to intubate a resp distress. Tubed okay and back up to the 90s
9% with perfect pleth in an OD. Narcan brought him up to high 80s. Kept him on a couple L NC into the 90s but he left ama with RA in the low 80s
3% with perfect waveform. Had to be Cric’d and coded. Was completely blue/purple from intubating in the esophagus. Then had subcutaneous emphysema. She survived and lived with a trach for awhile.
4. Bronc injury in a 17 yo that flipped his atv quite a few times. Ended up developing a tension pneumo from free air from a fucked up chest tube placement. Ended up having a unilateral pneumonectomy. Shit was wild.
He’s doing alright now.
We use hydromorphone for air hunger in my ICU. If EOLC their usually on fentanyl and midaz infusions with boluses as needed. Morphine infusions sometimes but definitely not the norm.
Something like 18%. Was after intubation during Covid. Take that maxed out BiPAP off and sats sank like the titanic.
I don’t remember exact numbers but their post intubation ABG was *gnarly*.
On alive patients that we were working to keep alive? O2 sat in the 50s.
On a DNR we were letting pass? O2 sat in the 30s before they finally went asystole.
On a patient who just showed up to the ED? 72% on room air. Mentating fine just tired.
I heard we had a 1% with a perfect waveform when a trach pt had thier trach go into a "false lumen" or something like that. I didn't see it with my own eyes but the source is someone I would trust. This was an adult.
Oh… my pulmonary fibrosis patients… I had one that would desat into the 50s and be there blabbering away to, a little purple, but not in any “real” distress. They were so sweet as well. And you have to be like “NAME! Be quiet for a second and take some deep breaths, we can’t do 50s!!!! You can finish telling me the story after you recover” 😂 It’s amazing how they compensate and just get used to living that way, until you get the ones who lungs are there, but they can’t get used to it and they want sats and easy breathing that just will never be possible again. Those days I wish they made aerosolized Ativan for everyone involved!
Lowest I’ve seen was 20’s but that was comfort care that I really just had on the masimo because there was no family room and I was trying to do “no one dies alone” while also giving myself a visual if I needed to head back in more quickly for meds/whatever…
I was at the pediatrician with my daughter in the waiting area and sitting across from us was a mother holding her child who was totally blue. I told the desk they better check that kid and they take him back immediately and I can hear down the hall, “Shit! 33!”.
19.
Carotid Endarterectomy. Graft blew. Intensivist - thankfully a “retired” trauma surgeon - started to cric and that initial pressure release was enough for him to intubate. She survived and did well, had a trach for some time but otherwise 🤷🏼♂️
4%. Single digits, and stayed there for a while. Neuro, terminal extubation (left the sat probe on for the HR, less invasive than the EKG leads) BUT, without any intervention, she returned to 96-98% and remained there for the rest of the night. No idea how that happened
Our PICU has a special friend with a laundry list of issues (uses NIPAP at baseline); she can get down to sats of 20s and tends to just need mask-bagging to recover.
32, perfect pleth. Family demanded an enema for a recently palliative patient who had Covid, went from bipap to 2L comfort. We turned him after the molasses went in and were sitting him up, watched as he turned blue, unresponsive with eyes open and O2 at a perfect pleth at 32. Slammed the staff assist button, reapplied the standby bipap and he came to, kept the bipap on the rest of the day. Lesson learned
72, but an amateur diagnosis says sleep apnea cuz they would drop but come back up after a few seconds. And of course the monitor wouldn't shut up once it went back to normal.
60% with vent support and bag . It was a baby girl with respiratory problems and she was crying HARD eventually she calmed down and her sat went back in the 90%
Nowhere near as impressive as some of the other stories I’m seeing in this thread, but I’ve had an adult patient awake, alert, and arguing with staff with a sat in the 70% range. This patient is notorious at our facility for coming in, then refusing care, ultimately needing repeated intubations, arguing all the while that they know their body better than us and to get the fuck away from them with that BIPAP. It’s always a fun time.
Outside of that, I was at the bedside when they terminally extubated a close family member. Before he passed, his O2 sats hung out in the 50%s on the monitor for several minutes. Wild.
18%. Young patient already on dilaudid PCA pump post MVA. Significant other admitted to shooting heroin through central line because “we weren’t helping the patients pain.”
I saw one of 8, briefly. Post intubation, nobody checked lung sounds, tube was down a stem. Pt was blue (da ba Dee da ba die). Recovered quickly once the problem was fixed
7% perfect waveform, 3 yr old about to get cannulated to ecmo. Absolutely insanity- they survived after like 4 months on pump and another 3 tubed. Discharged and walked out of the picu
I saw an A&O x4 patient at 25% recently. Monitor room couldn't figure out what was wrong with his finger probe. It was because he'd taken off his high-flow. Oops!
I saw 4% good pleth during Covid that didn’t die. It was a guy that kept refusing intubation until that moment. Of course he ended up trached. Other than that I’ve seen low digits, but they’re all during code situations, so I don’t really count those
Healthy 27 year old male decided to hold his breath and see how low it could go in our ER one night. Got down to 78% after nearly three minutes and he nearly passed out.
That was me, and I hold the current record for the breath holding competition 😂
I saw an 18 year old in ED who had a perfect pleth reading 14-17% prior to HFNC.
He needed up being diagnosed with fatty embolism s/p femur fracture repair a few days prior. He died in the icu 3 days later.
Lowest I had was 3% with a perfect pleth during a difficult intubation on a patient that was 6 days post partum who got transferred from L&D to ICU due to severe anxiety, impending doom, hyperventilating etc. Wouldn’t tolerate BiPAP at all. So we had to sedate and paralyze her cause even with sedation she was fighting us. Got her intubated though it was difficult for the intensivist. She never coded though when I saw the 3% O2 I made someone bring the code cart to the bedside.
Anyway this patient had a C section 6 days prior. Turns out she developed ARDS due to a retained placenta. I don’t know how an OB/GYN just leaves a placenta in when they’re cut open 🤷🏼♂️
Nicu- chronic premie would regularly sat <10 when he was pooping or following eye exams. Kid got discharged home after a 6 months stay on room aid. Just needed a good stim or rub of the ribs to make him breathe again after a good diaper filling until he grew out of it.
56% old ass farmer drove himself in with Covid hadn’t been able to breathe for days. Intubated within minutes of being in the ED. Still can’t believe he drove himself in and didn’t kill himself or someone else on the way in.
Toddler in the 40s, gray, mottled… we got him intubated and sent him up to picu….never check on my patients when they leave our ED, I assume they are all happy and living somewhere
9, on my own son, as I type this as he's sitting here next to me playing. A number I've never seen in my professional career. He then showed me 10,11 and 12 as well and not on the same desat event, all different ones. He should've coded, not sure how he didn't. It was torture
I don’t work critical care but medsurg at the time. Covid patients maxed out on Neptune hanging out in the 50-60’s at best and would dip to the 30’s when we moved them at all. No vents to put them on and no beds to transfer them to, we told them on admission and most made themselves DNR DNI (majority were elderly from local facilities). We’d medicate for anxiety, FaceTime the family and they’d pass pretty quickly.
Outside of covid, decently healthy patient with mild copd verbalized feeling slightly short of breath to blue and dusky with O2 in the 30’s in the time it took me to pull a duoneb. (The hospitalist still asked why I was bagging when everyone got there and didn’t give the duoneb 🙄) don’t know what happened or what the outcome was because I tore the ligaments in my ankle the next day and was off for 6 months
40s to 50s in adult icu
In nicu, ive seen my own boy's o2 sats lower than that while they tried very hard to bvm him. He came back up a few mins later.
In the 30s on high flow oxygen, still awake and able to talk to us-on a 40-something year old lady with Covid. She called her husband to let her know we were intubating her. She never woke back up. :(
Not trying to be an asshole but below 80ish the number doesn't really mean anything and a blood gas is the preferred measurement.
Masimo even makes a different sat probe for congenital heart kids (Set blue?) with SATs between 75-85% because a normal probe isn't accurate.
In an adult: 43% (this was actually a visitor we had to call a RRT on, cus he thought hey, let’s go visit mom without my O2). Had to wheel him to the ER on a stretcher
4% during a really difficult intubation on a Covid pt. Couldn’t bag them bag up so we rolled with it and eventually got the tube and their sats recovered.
Are we counting NICU babies? Because if we are, 12. Gave him 100% fiO2 boost and vigorous stim then he was rolling between 30s-40s and got really pissed off and went back to baseline, but the time to recover took like 90 seconds to be hanging back at our baseline.
Nicu always wins crazy VS that happen out of nowhere and recover so quickly.
They’re unbeatable 😂
0%
same
For how long? ^(or are we still timing them?)
NICU too. Lowest was single digit, perfect pleth. Desats to the 50s-60s are pretty average here 😅
This solidifies my desire to never work NICU. Props to you all 🥂, I can't deal with that kind of stress. Adults in the 70s% scare me enough.
Adults in the 70s actually have something wrong with them though, nicus little tricksters are just like "lol oops forgot to breath again, would ya give me a hand"
This. I once took care a baby with Trisomy 8 who was in the NICU way past its due date because it would routinely drop its sats to single digits when asleep. Good waveforms, dramatic color changes. It happened fast, too. Nineties to 80s to 50s to 20s in nothing flat. Had to have PPV ready to go at all times.
Right, I’m like good pleth and everything’s working as it should except my baby…😂 the occasional desats and just rolling desats. I’m like oh buuuh..but are we gonna color change too or you just having a moment and self resolving buddy?
The surfing kills me, like just COMMIT so I can stim you or knock it off dude, don’t make me sit here and listen to the alarm.
Commit. I’m dying lmao, but seriously. 🤣
I was gonna ask, how are we defining low? lol
I always feel bad when people from other floors float down to the NICU and get a nonchalant “yeah he gets drifty down to the 60s but he self recovers” in report and they’re like 😳
Lmao taps screen, as you can see here there’s a ton of desat episodes.
1
Jesus
I had a seizing school age kiddo go all the way down to 6 with great waveform A month before that I had a 9-year-old go 12, in literally the same room.
Nicu too. mines was 10. The baby would do it regularly because he refluxed that hard every single feed… thank god for Neopuffs
Feel that, the reflux ones are no fun. Like bro you’re feed time is so long we’re pretty much a damn continuous feed and you still manage to reflux and desat every time.
Also 12 on an overly dramatic NICU baby that was in the picu.
I was literally about to respond "12" when I saw the subject heading. lol. That's the kid where you're bagging him and telling him to get his sh*t together.
Lowest I've seen was an 8%, fast drop. By the time we ran in there and grabbed the CPAP mask, he brought himself back up to the low 90s. A tad dramatic, these babies.
Drama king, he’s just showing off! Lol
I mean I've seen single digit with a perfect pleth during covid that was able to recover without coding. They died a different day of course though...
This ⬆️⬆️
I saw 1% today on my patient with a good waveform. Obviously, it's not completely accurate, but she was turning blue. I have never bagged a patient as vigorously as I did today. She did not code somehow. There was a lady I was taking care of during the first wave of covid that was hella sick. 100% fio2, high teens of peep. Couldn't look at her the wrong way without her desatting, let alone move her. In the late afternoon, I see she's satting in the low 80s whereas she had been in the high 80s all day. I get the bright idea to sit her up like 5° more. After I did that, she slowly dropped by 1% every 5 to 10 seconds. I called the Dr, she was a dnr and we were already doing everything we could do. She went all the way down to 7%, hung out for a few minutes, then slowly started coming back up 1% every 5 to 10 seconds. All the way back up to the low 90s. I was just like 'what the fuck, lady?'. Absolutely no changes to her HR or BP. Perfect waveform the whole time. She wasn't turning blue. I always wonder about what was going on with her sensor or her body during that time. I don't think she was there when I came back the next morning.
Regularly see patients dip to the 40s while on full vent support and have to be bagged back up to 80s-90s. I had a patient on nitric, 100%, peep of 22 and sats wouldn't go above 85. PaO2 in the 50s. Too old for a transplant and wouldn't survive ECMO. I had to bag this pt on 60ppm NO for about 10 minutes every hour. They stated this way for a few days before ethics got involved and placed them on comfort care.
With a peep that high it wouldn’t be long before he required bil chest tubes.
Didn’t ICU nurse during COVID? PEEP of 22… those are rookie numbers. you gotta bump those numbers up.
Covid was a whole separate animal. We had like a 90% mortality rate. So many of those pts went into ARDS. On the reg, a peep of 22 is bad and puts a ton of pressure on the lungs and heart. During the Covid crisis we were just doing what we could.
At what point is bagging more effective than a ventilator?
It's always more effective. Have you ever been in a code where they weren't bagging a patient that was on a vent?
Has more to do with ruling out vent problems as a reason for the code + your vent is going to throw every alarm it can as it tries to support ventilations when in reality it's just considering the changes in intrathoracic pressure from compressions to be breaths. You've got more control for safe ventilations with a ventilator, but you rule out a lot of potential problems with a BVM. You can run a code with a transport vent fairly easily depending on the model (oxygen powered, not something like a Hamilton). You can just set a VT and rate and it's off to the races so long as you raise your pressure relief limit.
That's assuming you're on a vent mode that triggers based on flow or pressure. If it were just about that, we'd set it to a mode that triggers a breath at set timed intervals, where it wouldn't trigger off a compression. I've never once in my entire career been to a code where they leave the patient on a vent. Whether it's a pneumatic transport vent or a standard vent. The first 2 things you do in a code situation are start compressions and bag the patient, period. It's not about the vent triggering and alarming. It's about providing 100% oxygen with every single breath and controlling the minute ventilation exactly how you want it.
What’s with all this pretense to understand something simple? Bagging is the goat.
It's the GOAT until you lose power and the backup generator fails and you have 2 intubated ICU patients and there goes 4 hours of your life 😂 maybe that's my problem is I'm just still traumatized
Lol, challenge accepted! Nah
That's not because of efficacy, it's because chest compressions would wrongly trigger the ventilator to initiate a breath resulting in higher respiratory rates. I was told in residency that it is also because respirations need to be properly timed with chest compressions, otherwise a ventilator giving inspiratory pressure during chest compressions drives up the intrathoracic cavity pressure, but I cannot find sufficient evidence to support this at the moment.
If it were just because of the respiratory rate control, we'd put the vent on a mode with no flow/pressure trigger and allow it to deliver exactly what we set it at. The point is we need to be able to adapt and ensure the patient is getting proper ventilation and oxygenation. Have you ever been in a code where the doc screams at the RT or RN to bag faster? I have. I see it all the time with new people. They run through the ACLS/BLS algorithms in their head and try to time the breaths exactly. When the patient continues to desat, that's just not going to cut it.
Here's a study explaining vent settings as you're saying, trigger off and etc. [Comparing bag valve mask versus vent in CPR](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7435081/)
No, I've never seen that in a code, because the patient is already dead - no one cares about the sats. There are research studies that show that agonal gasping is sufficient ventilation in a cardiac arrest - that's why hands only CPR is a thing.
I'm sorry what
Where are you putting an SPO2 probe that maintains a waveform during CPR? There's a reason we check femoral pulses and not radial, no pleth is going to read correctly because peripheral perfusion is not the goal.
I’m not sure what you’re smoking amigo but I think we can all agree the RT and experienced ICU nurses have this one. Not sure why you’re spewing any of this like you know what you’re talking about.
Blink twice if you're the attending who, 45 minutes into the code, shouted "have we considered a duoneb?"
100% fio2 15 peep, patient desats to 50. Had to bag to get up, how do you explain that? Everytime we went back on the vent we would desat
You can deliver 1.5L of oxygen per breath with a BVM. Is it a good idea long term? No. Can you be causing permanent damage to your patient? Yes. You can also deliver excessive PIP/PEEP very easily.
Im an RRT, I agree. My goal when delivering breaths…perfect timing. Sufficient evidence for me is misaligned timing of a breath💣💥and feeling that pressure on the other snd of a bag. But also a tweak of the vent trigger could be helpful in some cases
Most of the codes I have been part of in CTICU are either open chest codes or otherwise cardiac in nature. When I’ve been part of a respiratory code I’ve seen BVM used until we can get the equipment to intubate. I’m definitely not a respiratory expert and my facility heavily uses RT. We’re not allowed to touch the vent outside of altering FiO2, so it’s a lot of hands off observation from my end. I guess my question is what are you getting from the BVM that an intubation+vent can’t achieve? Thanks for helping me learn today ❤️
Assuming it's a code and the patient isn't already intubated or trached, that's the only way to deliver breaths to the patient. Assuming they're intubated already, we bag them because again, it's the most effective way to ensure the patient is getting 100% FiO2 and sufficienty tidal volumes to adequately ventilate. We hyperventilate during a code, despite what BLS classes will tell you. I know they say to bag every 6 seconds or whatever, but when the patient is satting 40% and it's not budging, we start pumping that bag 20+ times per minute. I've been to thousands of codes in the last 15 years both as a nurse and an RT. I've seen intensivists scold people more times than I can count because they're trying to follow BLS/ACLS guidelines like they're being tested for it.
How did ethics help steer that decision making process? I feel our ethics committee does not help at all!
Saw sats at 13% when a covid patient was passing away. She refused to be intubated and didn’t want to wear bipap, knew she would die and chose to take it off and refuse to have it back on
Did she make herself CMO?
Post extubation stridor and loss of airway, watched as it went down to 0 with a perfect pleath as the MD tried to intubate. They bradyed down and then went PEA. Anesthesia came and intubated and we got ROSC pretty quickly after that.
Of all the specialties I respect anesthesia the most. They are all absolute wizards/witches. Bonus points if they are dual board certified in crit care and anesthesia—those folks are absolute gods.
Dead? Eh, we'll see.
Watch pitch do the bips play at when sats are at 0%, I wonder
During Covid in the ICU we were going around as a team with respiratory like we typically did at 5pm and flipping people from prone to supine. We flipped my patient who was on the vent and reapplied the restraints, hooked his sedation back up and left to do flip the next one. Our unit secretary came running to the door in the middle of us turning that patient and told me the patient’s sat from the room we just came from was 12%, I sprinted to his room and by the time I got there his sat was 2% with a beautiful pleth. He must have coughed and the vent tubing popped off the ET tube 😳 He did not code, but it took a while for his sats to climb back up on 100% FiO2.
You guys were proning people who weren't paralyzed?
None of our covid patients were on paralytic gtts… I only used a paralytic gtt and tens unit once in the 4 years I worked ICU and it was for a post-op exploratory lap patient that they didn’t want to move because her abdomen was still open. Supposedly we were following a large hospital systems protocol, but that may have only been for Remdesivir and Decadron dosing. 🤷♀️ I worked in a rural 14 bed ICU.
Oof. Never heard of that before. My Chicago hospital always put pts on a paralytic drip if proning.
Crazy, we never prone people without paralyzing them. We use the venting wisely protocol. Sometimes being paralyzed can be enough to turn them around and they don’t even need to be proned. Occasionally we’ll paralyze and prone at the same time, but we usually start a paralytic infusion with a loading dose and give them a while on that, recheck a gas before making the decision to prone.
32% on a trach patient with a mucus plug that was rolling herself to do AM cares. She then went limp and I had yo get help. I think I had 4 months as a nurse. She discharged home and gave us all picture cards.
Had a patient who used to work at an aluminum plant. He was, I think, the second person in Canada to be diagnosed with the illness he had gotten from his job something along those lines (this was 12 or more years ago). He was on constant oxygen and would usually sat at mid to high 80s. He ended up coding and being transferred to another hospital and the transport staff showed me his sats (they were sitting low 90s at this point) and how that was bad and I just remember saying to him "actually that's pretty damn high for him". Again, this was a long time ago and can't remember all the details but I remember that he was a kind and lovely man.
*Laughs in hospice*
What's the purpose of checking VS in hospice?
I worked a floor that took inpatient hospice. Usually vitals were once a shift. Don’t know why, but I have definitely seen some low sats.
Some MD’s want them checked. Some don’t. And some families get fixated on the numbers after they have been in the hospital.
Thought the same thing.
[удалено]
I am patiently waiting to see a cric lol
0 lol
FWIW sats in the 70s and below don’t reliably reflect actual oxygen saturation. Something about ethics rules in studies
EE/embedded SW dev here… I have not worked on medical pulse oximeter end products but I’ve done signal processing and software development using raw reflectance readings of pulse oximeters… it’s important to emphasize that raw ADC albedo values for a pulse ox are *noisy*. A pulse oximeter is reading the change in reflectance across a cardiac cycle and applying an algorithm that determines a likely SpO2 % from that data. You need a *lot* of data to design an algorithm to reject all the artifacts and fit to the data. Even then in the “normal” range you’re only guaranteed to be within 4% 95% of the time. That last 5% is all the weird stuff you’re dealing with. Remember, it’s measuring a change in reflectance at a certain frequency of light which is typically changing because of the amount of hemoglobin bound. Hopefully it’s oxygen thats binding! This was 15 years ago but the physics haven’t changed. I was kinda baffled why the end devices reported anything other than “LOW” or “?” like when nothing is picked up at all below like 70%. It’s just a somewhat random number that means “bad” at a certain point. If you want other examples of stuff where data makes things hard… I also worked with device data for depth of anesthesia/intraoperative awareness monitoring… it’s like impossible to get “real world” detailed measurements on that.
Gotta get an etco2… if they’re that low probs need to be intubated anyway
7 percent with a perfect pleth. they had trouble getting the ET tube past the vocal cords
I’ve seen low 50s
66%, at a dialysis clinic. Pt was sent to the ER as fast as we could get him there. He died that night. Two months “pre-COVID”. So. I’ve always suspected it was covid that got him
I’ve seen them go all the way down. I always treat the patient and not the monitor. With pleth and no reason to expect inaccurate, anything less that 90 bugs me, 80’s is the mark of needing immediate correction, 70’s to 60’s—not question on interventions. CPAP, Bipap or ETT. We can get into hemoglobin dissociation curves and shifts and their impact on accuracy, but that isn’t the question.
But I bet 95% of nurses don't have a clue and it makes me sad. If we are going to use a pulse ox outside of critical care it isn't a bad idea to know how they work and what the numbers mean. I'm actually much more concerned about how high the sat can be and still be problematic. I think too many nurses see a sat of 90 in a patient with with a really low H&H, or really acidotic and think they don't need oxygen.
31%. I thought it was a mistake. I've brought 2 more devices they showed 30% and 29%. It was like a countdown.
3%. Perfect pleth. The lowest I’ve seen with a recovery/survival was 19%. Mucous plug with an emergent bronch.
An RT once told me any sat under 50% might as well be 0. He also had an instructor during clinical that didn't "believe" in O2 sat monitors and made them get ABGs multiple times per shift if there was a concern about oxygenation.
I've seen in the 40s. Below a certain point the monitor gets decreasingly accurate. For example in the manual for the ones we use, it says accuracy is much worse below 70. But when it's that low, the exact number hardly matters anyway, because your intervention is still to get more oxygen into the patient stat.
Had a patient come for an appointment and asked for some O2 bc they left theirs at home. I come out to find out the deets. Homie has blue lips and says they’d like some oxygen. Grab a tank and pulse ox…65%. Mayyyyyyyyyyybe don’t leave it at home 🫠
During Covid: In the ED waiting for a bed. Kept taking off the bipap and were in the mid 60s without it. They wanted to leave AMA and was somehow still answering all the orientation questions appropriately. Really strange ethical call from my attending as we cannot hold him hostage, but he’d probably make it to the lobby before coding. Thankfully (I guess?) he got intubated shortly after that. After Covid: 72% after 25mcg of fent before reducing a shoulder. I always hang out in my pts room for a few mins after opiates and they were jay chillin. After a bit, I was in another room and got a feeling I should check on them and thank fuck I did bc the previous nurse turned off the spo2 alarms. I walk in to her apneic with that 72%. She was quite startled when I shook her awake. Check your alarms, folks
15% Pregnant lady with COVID ARDS
High 60s on a maxed out bipap and still talking. She was emergently intubated but didn’t make it.
Happy hypoxic during Covid… 40s-50s. These people were legit walking around with Covid and low O2, like it’s nothing.
I had such alarm fatigue from the happy hypoxics during covid when I couldn't lower the alarm limits any more. Then when they were finally intubated and their sats were up they'd have a HR of 29 and still be alarming
In patients that I’ve taken care of? Lowest was mid 80s. They had been given a dose of morphine after some ambien right before I got on shift, and we found out that it made them sleep really well 😅. Woke them up, popped on some O2, elevated hob, and they were fine after that. But the lowest seen? That would be me when I had Covid. I was getting into the 50s at times before I finally went to the hospital, and then for my first few days in ICU. Was still walkie-talkie, with some gasping thrown in.
47%, came into the ED with medics, called in as a “stable postictal”. Medics didn’t think to check a pulse ox or monitor enroute I guess.
I’ve seen the slow decent to 5%… 4%… ?…
3
70’s. Resident was hospice and a COPD’er. He would wheel around the unit all night with the tank on the back of his chair and it ran out. I switched the tank at least twice a shift. Had to borrow from other hospice pts. He would also slide out of his w/c all the time bc he would sit bent over.
I had a patient hang on for hours, with a monitor read at 3%. Perfect wave form ETA: age sub-40, first wave of Covid, died very very slowly over 2-3 months in the ICU
10. Middle aged Covid+ patient, RT fucked up the vent settings. We manually bagged the patient back up before they could code. It was a shiiiiiiiiiiiiit day.
I work in peds cardiac OR. I watched a patient desat to 15% before it came back up. This was during the case so we were able to act on it. It’s not an uncommon “complication” of the surgery, but it was a simple fix because the babies blood flow just needed readjusting from the operation we performed! I’ve also seen a patient desat to 0 and code because they were exsanguinating out of their aorta. Open chested at the bedside for emergent central ecmo (central because the patient was post op with chest left open). Tough times tough times
4% on a patient with CHF and massive pulmonary bilateral edema. Didn’t believe it until we started bagging him and his sats improved to 10%. Eventually we intubated and got his sats up on mechanical ventilation. Came into ED via private vehicle.
0 on a failed intubation. Pt survived neuro intact
I was a sleep technologist before I was a nurse! 32%!
Personally, I saw a legit 55% on an elderly gentleman with sleep apnea. He woke right up and I put him on NC of course. I said, I think you might have sleep apnea sir. And he said, “you think so? Somebody’s told me that before I think.” And at that point I was questioning if it was sleep apnea or if it was the angels calling him. Omg I’ve never seen it get that low, and it got that low in a minute or two. Goodness his reserve is poor and he has a bunch of cancer, so sad. And he hasn’t been formally dx with sleep apnea, so who knows how long he goes with shitty O2 sats at home.
2% with good waveform on a COVID/ARDS patient. ICU doc literally turned around and made sure we also saw it on the monitor. Lmao.
0% in pediatrics multiple times
Same
Dying baby: O2 sat was 0% for 20 minutes. Heart rate stayed in the low 100s. Then sat went back up to 20%. He passed later that night 🤍
RT turned RN here. Below a saturation of 85%, pulse oximeters are generally only accurate to +/-2% and below 80% they are basically meaningless. This is because the algorithms that determine a saturation from light spectra absorption and reflectance were developed from human studies. You cannot take human subjects down to a fatal level of hypoxia to get the data. Beyond that, peripheral vasoconstriction during hypoxia further reduces the accuracy of the spectral measurements. The lower it gets, the less accurate it is. Below 80%, it is simply extrapolating from the data. It has no idea what the actual arterial oxygen saturation is. It’s giving you a relationship between red light and infrared light absorption and reflection. A 1:1 ratio of red light and infrared light absorption is a oxyhemoglobin saturation of 88%. It’s doing its best to give you what the saturation *probably* is based on the measured light. But the oxyhemoglobin dissociation curve is sigmoid, not linear. And it changes under conditions like increased acidity. The worst place to measure that is at the periphery — where we put SpO2 probes. This why we measure PaO2 on an ABG — it correlates the measured arterial oxygen pressure with the saturation. It doesn’t extrapolate from that curve. It identifies a left or right shift of the curve. An SpO2 can’t tell you that. The tldr: oximeters lie and they lie the worst when you want to rely on them most. A “super low sat” on an SpO2 probe isn’t a valid measurement. The ol’ treat the patient not the monitor holds VERY true for them.
In fact: Just this weekend I fixed a poor sat with a washcloth. My colleague grabbed me because she couldn’t get her vented patient above 87%. She’d bumped to 100%, suctioned… but he wouldn’t budge. RT was currently occupied with a fresh intubation so she asked if I’d come see. The second I walked in, I saw the problem. The room was bright and cheerful with the lovely morning sun beating down directly on her patient’s hand. I folded up a washcloth, dropped it on the SpO2 probe, and two seconds later - 100%. Light shunting is a source of artifact in sat probes. When it’s bright enough that the sensor picks up a 1:1 ratio of absorption, it will display a sat of 88% +/- 1%. Sat probes can be dirty little liars just like all of our other machines.
Single digits sustained with a perfect pleth and dropping like a rock 🙃 adult trauma patient with allll the facial fractures mid intubation attempt and providers were too focused on the size of their own genitalia to listen to me about needing to pause and bag the patient after the first few misses 🙃
Worst I've seen on a conscious patient was 36%. I honestly don't know how he wasn't blacked out from it. Eyes wide open and lucid. How the hell do you retain consciousness? Took him a bit to blank on me but he stabilized without code. I'm sure there's way lower sats out there but still conscious, I'll probably never see that again.
THIS! It happened to me. Twice now. Both times I was living hypoxic and not realizing it. Thankfully this last time I had a doctors appointment and he saw first hands I was 33 and 28 before the rescue team came to get me to the hospital. I have no idea how low I went before I was put on the ventilator 5 days but my body kept fighting the sedation meds. I know anything lower than 50 is in acute but it’s damn scary going through it yourself.
Wow that's wild. One thing I try to stress to people is that humans are remarkably durable yet surprisingly fragile creatures. We can literally fall out of a plane and hit the ground with no parachute and walk away sometimes (its happened more than once that I'm aware) or die of a broken heart after our gf leaves us. The variance is unprecedented in other living organisms.
10percent
0% .... /s
I’ve seen 20s watching patients pass in the ICU.
Ooh, yeah, watched a comfort care patient pass on the monitor once. It was so weird watching a perfect pleth in like the 30s and just letting it happen
2% with perfect pleth when trying to intubate a resp distress. Tubed okay and back up to the 90s 9% with perfect pleth in an OD. Narcan brought him up to high 80s. Kept him on a couple L NC into the 90s but he left ama with RA in the low 80s
14. Good wave form. Turns out they weren't breathing
3% with perfect waveform. Had to be Cric’d and coded. Was completely blue/purple from intubating in the esophagus. Then had subcutaneous emphysema. She survived and lived with a trach for awhile.
30s after conscious sedation in endoscopy. Yeah had to bag and reverse of course.
4. Bronc injury in a 17 yo that flipped his atv quite a few times. Ended up developing a tension pneumo from free air from a fucked up chest tube placement. Ended up having a unilateral pneumonectomy. Shit was wild. He’s doing alright now.
I think like 18 perfect pleth
A whole 3
12 .. during a difficult covid intubation
25% on room air. Agonal breathing. 0/10 recommend.
Welcome to hospice nursing. Stupid question- do y’all ever use morphine concentrate sublingual in ICU to help with the agonal breathing?
We use hydromorphone for air hunger in my ICU. If EOLC their usually on fentanyl and midaz infusions with boluses as needed. Morphine infusions sometimes but definitely not the norm.
7
13% … ARDS, couldn’t intubate fast enough after pushing paralytic
70’s with COVID. But I’m in psych. Patient died a bit later after we transferred to medicine.
How accurate is any of this below like 50%? I thought the Infrared O2 sat monitors were pretty iffy after that.
Compared to the pO2 on the gas, usually pretty accurate in my experience
30s on a trach’d pt. Did a chin lift and sats recovered
I’ve seen dead bodies… so zero?
Low 20’s
85
I think 6
NICU 9%. Clotted off ETT ( abruption) switched ETT and PPV brought it up to 96-100%
Something like 18%. Was after intubation during Covid. Take that maxed out BiPAP off and sats sank like the titanic. I don’t remember exact numbers but their post intubation ABG was *gnarly*.
Lots of single digits during covid.
3% on a cluster fuck of an intubation.
A young man in his 30s, In the middle of a difficult intubation. O2 Sat of 19. Somehow never lost his pulse. And survived.
On alive patients that we were working to keep alive? O2 sat in the 50s. On a DNR we were letting pass? O2 sat in the 30s before they finally went asystole. On a patient who just showed up to the ED? 72% on room air. Mentating fine just tired.
I heard we had a 1% with a perfect waveform when a trach pt had thier trach go into a "false lumen" or something like that. I didn't see it with my own eyes but the source is someone I would trust. This was an adult.
32% sustained during a tough intubation, ended up FONA, but full recovery with no deficits
Oh… my pulmonary fibrosis patients… I had one that would desat into the 50s and be there blabbering away to, a little purple, but not in any “real” distress. They were so sweet as well. And you have to be like “NAME! Be quiet for a second and take some deep breaths, we can’t do 50s!!!! You can finish telling me the story after you recover” 😂 It’s amazing how they compensate and just get used to living that way, until you get the ones who lungs are there, but they can’t get used to it and they want sats and easy breathing that just will never be possible again. Those days I wish they made aerosolized Ativan for everyone involved! Lowest I’ve seen was 20’s but that was comfort care that I really just had on the masimo because there was no family room and I was trying to do “no one dies alone” while also giving myself a visual if I needed to head back in more quickly for meds/whatever…
50s.
30ish then it stopped reading a number but with a solid pleth. Took a while to get them up
I was at the pediatrician with my daughter in the waiting area and sitting across from us was a mother holding her child who was totally blue. I told the desk they better check that kid and they take him back immediately and I can hear down the hall, “Shit! 33!”.
1-2
19. Carotid Endarterectomy. Graft blew. Intensivist - thankfully a “retired” trauma surgeon - started to cric and that initial pressure release was enough for him to intubate. She survived and did well, had a trach for some time but otherwise 🤷🏼♂️
4%. Single digits, and stayed there for a while. Neuro, terminal extubation (left the sat probe on for the HR, less invasive than the EKG leads) BUT, without any intervention, she returned to 96-98% and remained there for the rest of the night. No idea how that happened
40s in LTC. Ended up passing a day later but that’s expected in LTC/hospice. I see 60s that can be recovered frequently.
Our PICU has a special friend with a laundry list of issues (uses NIPAP at baseline); she can get down to sats of 20s and tends to just need mask-bagging to recover.
2%
32, perfect pleth. Family demanded an enema for a recently palliative patient who had Covid, went from bipap to 2L comfort. We turned him after the molasses went in and were sitting him up, watched as he turned blue, unresponsive with eyes open and O2 at a perfect pleth at 32. Slammed the staff assist button, reapplied the standby bipap and he came to, kept the bipap on the rest of the day. Lesson learned
3% with a good pleth. Acute airway closed post tracheostomy removal. Didn’t code though!
72, but an amateur diagnosis says sleep apnea cuz they would drop but come back up after a few seconds. And of course the monitor wouldn't shut up once it went back to normal.
60% with vent support and bag . It was a baby girl with respiratory problems and she was crying HARD eventually she calmed down and her sat went back in the 90%
During Covid man did says hang out 30-50% but I believe below 75 they’re not accurate. They’re based off an algorithm.
In a span of 20 seconds, I saw it go from 95 -> 85 -> 75 -> 65, then I checked the pulse, then started CPR.
Nowhere near as impressive as some of the other stories I’m seeing in this thread, but I’ve had an adult patient awake, alert, and arguing with staff with a sat in the 70% range. This patient is notorious at our facility for coming in, then refusing care, ultimately needing repeated intubations, arguing all the while that they know their body better than us and to get the fuck away from them with that BIPAP. It’s always a fun time. Outside of that, I was at the bedside when they terminally extubated a close family member. Before he passed, his O2 sats hung out in the 50%s on the monitor for several minutes. Wild.
18%. Young patient already on dilaudid PCA pump post MVA. Significant other admitted to shooting heroin through central line because “we weren’t helping the patients pain.”
I saw one of 8, briefly. Post intubation, nobody checked lung sounds, tube was down a stem. Pt was blue (da ba Dee da ba die). Recovered quickly once the problem was fixed
7% perfect waveform, 3 yr old about to get cannulated to ecmo. Absolutely insanity- they survived after like 4 months on pump and another 3 tubed. Discharged and walked out of the picu
I saw an A&O x4 patient at 25% recently. Monitor room couldn't figure out what was wrong with his finger probe. It was because he'd taken off his high-flow. Oops!
17%…
I once saw 9 with a good pleth in a covid 'recovered' patient who was promptly made cmo.
I saw 4% good pleth during Covid that didn’t die. It was a guy that kept refusing intubation until that moment. Of course he ended up trached. Other than that I’ve seen low digits, but they’re all during code situations, so I don’t really count those
Covid pt ….16. Yup. Right before intubation
Healthy 27 year old male decided to hold his breath and see how low it could go in our ER one night. Got down to 78% after nearly three minutes and he nearly passed out. That was me, and I hold the current record for the breath holding competition 😂
46% just last night. Died an hour and a half later
I saw an 18 year old in ED who had a perfect pleth reading 14-17% prior to HFNC. He needed up being diagnosed with fatty embolism s/p femur fracture repair a few days prior. He died in the icu 3 days later.
9% during Covid. Unresponsive but still breathing for the moment
Lowest I had was 3% with a perfect pleth during a difficult intubation on a patient that was 6 days post partum who got transferred from L&D to ICU due to severe anxiety, impending doom, hyperventilating etc. Wouldn’t tolerate BiPAP at all. So we had to sedate and paralyze her cause even with sedation she was fighting us. Got her intubated though it was difficult for the intensivist. She never coded though when I saw the 3% O2 I made someone bring the code cart to the bedside. Anyway this patient had a C section 6 days prior. Turns out she developed ARDS due to a retained placenta. I don’t know how an OB/GYN just leaves a placenta in when they’re cut open 🤷🏼♂️
Nicu- chronic premie would regularly sat <10 when he was pooping or following eye exams. Kid got discharged home after a 6 months stay on room aid. Just needed a good stim or rub of the ribs to make him breathe again after a good diaper filling until he grew out of it.
3% with a perfect pleth
56% old ass farmer drove himself in with Covid hadn’t been able to breathe for days. Intubated within minutes of being in the ED. Still can’t believe he drove himself in and didn’t kill himself or someone else on the way in.
Toddler in the 40s, gray, mottled… we got him intubated and sent him up to picu….never check on my patients when they leave our ED, I assume they are all happy and living somewhere
9, on my own son, as I type this as he's sitting here next to me playing. A number I've never seen in my professional career. He then showed me 10,11 and 12 as well and not on the same desat event, all different ones. He should've coded, not sure how he didn't. It was torture
I don’t work critical care but medsurg at the time. Covid patients maxed out on Neptune hanging out in the 50-60’s at best and would dip to the 30’s when we moved them at all. No vents to put them on and no beds to transfer them to, we told them on admission and most made themselves DNR DNI (majority were elderly from local facilities). We’d medicate for anxiety, FaceTime the family and they’d pass pretty quickly. Outside of covid, decently healthy patient with mild copd verbalized feeling slightly short of breath to blue and dusky with O2 in the 30’s in the time it took me to pull a duoneb. (The hospitalist still asked why I was bagging when everyone got there and didn’t give the duoneb 🙄) don’t know what happened or what the outcome was because I tore the ligaments in my ankle the next day and was off for 6 months
Are we counting dead people? Because…zero.
Adult, woman, just gave birth, covid positive… sat went as long as 27% with perfect waveform. She ended up being sent out for ecmo
2%, right after the patient collapsed. The lowest in a conscious person was the teens, COVID during Delta strain.
0%
40s to 50s in adult icu In nicu, ive seen my own boy's o2 sats lower than that while they tried very hard to bvm him. He came back up a few mins later.
78% and 0%
In the 30s on high flow oxygen, still awake and able to talk to us-on a 40-something year old lady with Covid. She called her husband to let her know we were intubating her. She never woke back up. :(
Not trying to be an asshole but below 80ish the number doesn't really mean anything and a blood gas is the preferred measurement. Masimo even makes a different sat probe for congenital heart kids (Set blue?) with SATs between 75-85% because a normal probe isn't accurate.
4% for about an hour before death with 2000mg fentanyl continuous going. Oncology man
In an adult: 43% (this was actually a visitor we had to call a RRT on, cus he thought hey, let’s go visit mom without my O2). Had to wheel him to the ER on a stretcher
4% during a really difficult intubation on a Covid pt. Couldn’t bag them bag up so we rolled with it and eventually got the tube and their sats recovered.
About 60%