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RAD 57 Pulse CO-Oximeter [Carboxyhemoglobin Monitoring]

Clinical Indications: Last update 02/2009

Subject: RAD 57-C Pulse CO Oximeter [Carboxyhemoglobin Monitoring]

Section 1 Purpose

    Carboxyhemoglobin monitoring is used to determine if carbon monoxide levels are present in firefighters, patients and occupants with possible exposure to carbon monoxide. If levels are present, determine course of treatment needed.

Section 2 Scope

    SpCO readings can be used as an additional screening measure to determine exposure to carbon monoxide. SpCO readings can also be used as a tool of inclusion/exclusion on vague medical complaints to reduce the risk of undiagnosed carbon monoxide poisoning. When SpCO is used in conjunction with SPO2 it gives a higher index of suspicion of hypoxia and indicates a need for aggressive treatment.

Section 3 Responsibility

    It shall be the responsibility of all personnel to use this device appropriately and responsibly, adhering to the enumerated indications.

Section 4 Indications

    SpCO monitoring shall be indicated for the following conditions:
      1. Post-incident firefighter screening on all fires.

      2. Firefighter rehabilitation in accordance to NFPA 1584.

      3. Extended time on or near fire-ground.

      4. Multiple SCBA bottle use.

      5. Suspected carbon monoxide exposure from work performed in confined spaces.

      6. Carbon monoxide alarms/gas leaks without symptoms in conjunction with gas detectors to determine presence and exposure.

      7. Multi-patient presentation.

      8. Headache, dizziness, syncope, weakness, altered mental status, and/or lethargy.

      9. Shortness of breath, chest pain.

      10. Nausea, vomiting, abdominal complaints.

      11. Any ill or injured patient with vague complaints.

Section 5 Recommended Usage

    For use during firefighter rehabilitation and as a screening tool on occupants without complaints regardless of whether known or unknown exposure. The following guidelines will be used as a baseline for detecting SpCO levels:
      1. 0 - 3% Normal, no treatment required
      2. 3 - 12% Yes - signs and symptoms or history of exposure TREAT
      3. 3 -12% No - signs or symptoms, no history of exposure OBSERVE
      4. 12% and higher TREAT and TRANSPORT

Treatment: 100% oxygen by non re-breather mask and transport to hospital is highly recommended.

    Any symptomatic patient regardless of SpCO levels in known exposures will be transported.

    Consider contacting a hospital that has a Hyperbaric Chamber for the following patients:

      1. Adults with an SpCO level 25% or higher
      2. Pediatrics with an SpCO level 15% or higher
      3. Pregnant females with an SpCO 15% or higher

    For use on patients with vague flu-like symptoms to include nausea, vomiting, headache and lethargy. Also to be used when there are multiple patients complaining of similar signs and symptoms.

Section 6 Documentation Recommendations

    When SpCO monitors are used for screening of asymptomatic patients and/or occupants and no readings are present, then document in patient care report [MedUSA] and/or SunPro report along with the gas detector reading.

    When used for firefighter rehabilitation and occupants with positive, low to moderate level readings that are asymptomatic complete the Firefighter Rehabilitation log.

    When used for symptomatic and/or high level readings complete a patient care report [MedUSA].

Section 7 Special Considerations

    SpCO RAD 57-C is not intended to be used on pediatric patients

    Smokers may have baseline SpCO readings up to 10%.

    Pregnancy: Fetal SpCO may be 10 - 15% higher than maternal readings.

    Inaccurate readings may occur due to misplaced/dislodged probes.

    Do not utilize thumb or 5th digit [pinky finger] for readings.

    Never utilize tape to secure probe.

    Person with suspected or known exposure to carbon monoxide. Rehab of Firefighters on fireground or training operations for possible exposure to carbon monoxide

Procedure:

    1. Apply probe to patient's middle finger or any other digit to cnter of fingernail as recommended by the device manufacturer. If near strobe lights, cover finger to avoid interference and/or move away from lights if possible.
    2. Allow machine to register percent circulating carboxyhemoglobin.
    3. Record CarboxyHb procedure in patient care report [MedUSA] or on the scene rehabilitation form. Also record Sao2 from RAD 57
    4. Verify pulse rate on machine with actual pulse of the patient.
    5. Monitor critical patients continuously until arrival at the hospital. If recording a one-time reading, monitor patients for a few minutes as oxygen saturation can vary.
    6. Document percent of carboxyhemoglobin every time vitals signs are recorded and in response to therapy to correct CO exposure.
    7. Use the pulse oximetry feature of the device as an added tool for patient evaluation. Treat the patient, not the data provided by the device. Utilize the CO Exposure protocol for guidance.
    8. The pulse oximeter reading should never be used to withhold oxygen from a patient in respiratory distress or when it is the standard of care to apply oxygen despite good pulse oximetry readings, such as chest pain.
    9. Factors which may reduce the reliability of the reading include:
      Poor peripheral circulation (blood volume, hypotension, hypothermia and vasoconstrictors)
      Excessive external lighting, particularly strobe/flashing lights
      Excessive pulse oximeter sensor motion
      Fingernail polish (may be removed with acetone pad)
      Irregular heart rhythms (atrial fibrillation, SVT, etc.)
      Jaundice
      Placement of BP cuff on same extremity as pulse ox probe
    0 - 4% normal value
    > 5% possibly some exposure
    > 10% alarm will sound. High CO exposure and start treating patient appropriatly and rapid transport to closest appropriate hospital.

Competency Based Skill Requirements:

    Maintain knowledge of the indications, contraindications, technique, and possible complications of the procedure. Assessment of this knowledge may be accomplished via quality assurance mechanisms, classroom demonstrations, skills stations, or other mechanisms as deemed appropriate by the Fort Lauderdale/ Broward Sheriff's Office Fire Rescue Joint Protocol Committee.

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