Sats of 78% !!!

I think I am going to have to get faster at doing and reflecting and getting it down in written form!

I am on my Cardio rotation at present and have been working with mainly medical patients so far – lots of COPD with exacerbations and infections of, and have found judging clinical status very difficult.

Most of the patients I’ve seen have resting sats of 90 – 95% on oxygen via NP, are incredibly breathless, look very ill and need to be ambulated as part of their treatment. We were sent off to see patients by ourselves on the 2^nd day and were given little direction, which made it a bit difficult but we bravely set out. We had been told that you can let the sats get to 85% in these types of patients and to monitor by symptoms more than sats to direct exercise prescription. For 2 of our patients after walking them about 6m their sats dropped to 88%, and so we sat them down after which they dropped to 76%. Needless to say we both almost had arrests ourselves and couldn’t believe we were about to have caused sudden death to trusting patients, and surely this could have been prevented if they had just stayed resting in bed…After a very long few minutes of us repeating incessantly “breathe deeply through your nose” and looking despairingly white – faced at each other as the accomplice to a murder, their sats did return to 90% and we joined them sitting down for a while. But then what next….was that alright….should we carry them back to bed and say never get out again which seemed like the most sensible option……so we went and found the PT who looked amusedly at our anxious white faces and said that was fairly standard, and not to worry too much about sats and watch for symptoms and why didn’t we turn up the oxygen…All of these comments for me did not clear up the situation at all; surely we aren’t allowed to just change the oxygen flow rate in COPD patients, how do you measure breathlessness and symptoms when they start by being incredibly breathless and looking pale and sick at rest??? All questions I am keeping for my Curtin supervisor…but in the meantime any experience or suggestions would be greatly appreciated!

In reflection then I have found it a bit different and difficult being the PT who has to make clinical calls and judgments about exercise capacity and exercising the patients, rather than being the nurse who lets the physio do it and just makes them comfortable!! Also knowing facts on paper and the theory of it all is very different when faced with the real patient and clinical scenario….and patients can actually survive on sats of 78% and recover!!!