Essential ER monitors

When asked to name his top two essential ER monitors, CVC educator Garret Pachtinger, VMD, DACVECC, doesn't hesitate: the pulse oximeter and the end-tidal CO2.

“The pulse oximeter is a great, noninvasive tool to determine if our patients have adequate oxygen levels,” says Dr. Pachtinger. While he admits it isn't perfect or even the gold standard for measuring oxygen levels, Dr. Pachtinger says his appreciation for the pulse oximeter stems from the fact that it's an “inexpensive tool you can use over and over on all of your patients to make sure their oxygen levels are normal.” And he also points out that you can use the pulse oximeter with patients under anesthesia to make sure they're oxygenating well.

Dr. Pachtinger recommends getting a pulse oximeter that provides a waveform associated with the number reading to ensure correlation with the heartbeat and the pulse.

“The waveform gives me a lot more confidence that the number the monitor is reading-whether it's a 92 and I'm worried, or it's a 97 and I'm happy-really correlates to that patient,” he says.

But Dr. Pachtinger says he doesn't rely TOO heavily on the technology. He encourages emergency clinicians to use their hands, eyes and ears in addition to the monitor.

“Auscult patients and feel their pulses,” he says. “If the pulse oximetry machine is reading a 96 but has a heart rate associated with it of 70, and you auscult the patient or feel the pulse and it's really 120 or 140, it's not reading appropriately.”

The other monitor in Dr. Pachtinger's repertoire of essential ER monitors is the end-tidal carbon dioxide (CO2) monitor: “It helps us measure ventilation. If a patient's CO2 levels are too high or too low, that can cause catastrophic events. Is that patient under anesthesia not breathing fast enough? Do we need to breathe for them to blow off that CO2?”

For a patient that's arrested, an end-tidal CO2 monitor can provide the first hint that the patient's coming back to life, says Dr. Pachtinger. Here's his take:

“Normally, if the patient doesn't have any spontaneous circulation, CO2 levels are going to be low (8s, 9s and maybe 10s). Or if you've intubated the patient, not down the trachea as you should, but down its esophagus accidentally in the rush of an arrest, maybe that end-tidal CO2-cause there's not a lot of CO2 in the stomach-will be 0, 1 or 2. But if you've intubated the patient properly ... even before you feel it have a good heartbeat or auscult it or see the electrocardiogram dramatically change, return of spontaneous circulation, or ROSC, may show those CO2 levels come back up to the 20s or even 30s, saying you're doing a good job-the patient is coming back to life.”

Dr. Pachtinger has more vital thoughts on these monitors. Check out the video below.