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    Care with SpO2 readings

    Most of us probably have SpO2 sensors at home.

    Most might know them as pulse oximeters. These give a reading which tells us what our oxygen levels are. So the reading for a "normal" individual might be 97 for example. The accepted healthy level has reduced over the years and in fact the accuracy is usually + or - three to six percent.

    For patients in Intensive Care who are seriously ill the accuracy of these devices (even the large monitor driven devices has sometimes to be taken with a pinch of salt), as I had to advise the Royal Free at the start of the COVID pandemic.

    What these sensors are not doing is measuring your CO2, I know it sounds a but silly, but you can have normal 02 levels and your body can also have higher than normal CO2 levels as your lungs are finding it difficult to get rid of the CO2. Hence why they will do an arterial blood test to check your CO2 levels as well.

    People commonly think that the highest form of intensive care is when a patient is on a ventilator in hospital. As some might know the highest form of intensive care is ECMO. This is where a hollow fibre bundle is used as a replacement for your lungs and an ECMO pump is used to perform the function of your heart.

    It used to be that every cardiac surgery unit in the UK would do ECMO, but they found that most of the patients were dying, so then they concentrated it to a few specialist centres.

    In more recent times normal intensive care departments have been able to use a halfway house, which is called ECCOR, this is a method of removing CO2 directly from the blood and giving the lungs a rest. As it is a halfway house, this is used for patients who are not desperate for oxygen, but have an issue with removing CO2.

    Most normal hospitals respiratory departments will not have a detailed knowledge about CO2 removal, nor will they be equipped.

    CO2 is a very interesting gas. Atmospheric CO2 is about 0.04 percent. In an office in an afternoon it is about 0.12 percent (hence why you feel drowsy in an office in the afternoon). It is about 1.5 times the density of air and will sit like a liquid in a room.

    So if you want "fresh air" in a room, open vents at the bottom rather than the top. CO2 is unusual in that it doesn't keep to the rules of the kinetic molecular theory of gases. That is a molecule of gas is not meant to have an attractive force to another. CO2 does, so you can fill a glass with it and it will stay there.

    At about 3 percent it will affect thought processes.

    I can say that if you breath in 100 percent CO2 you don't gasp. You just don't have a clue what is going on around you.

    I had better shut up now.


    #2
    Well that was very interesting. Thank you. Most departments don't know mnd suffers shouldn't have oxygen because of problems dealing with co2. Which is what happened to Stephen.
    when i can think of something profound i will update this.

    Comment


      #3
      denise I agree that most departments don't know.

      At the start of COVID (in my professional capacity I suggested that the next ten patients should go onto ECMO at any of the specialist centres). I was shot down by a number of the teaching hospitals, until a senior cardiac surgeon pointed out the lack of experience of most intensivists.
      Funnily enough lots of patients then went onto ECMO.

      I will stop being professional now and start talking about cake again.

      My son did try and call me back about the bangs in Plymouth, but I was giving someone directions who was on the M25

      Comment


        #4
        Christopher thank you, very interesting
        Diagnosed 18th May 2021 with sporadic ALS. Limb onset. Terrified of not being able to breathe easily.

        Comment


          #5
          Rosemary6NT unfortunately I could bore everyone senseless and talk for weeks/months/years about CO2 , probably on ECMO too.

          I would not suggest breathing any amount of CO2 in though.

          After one research session I thought I will go and have my sandwich in the car. I couldn't work out how to open the door. Then I got in and said "there is this thing in front of me, how am I meant to move". It was the steering wheel

          Comment


            #6
            Originally posted by Christopher View Post
            ... ECCOR [...] this is used for patients who are not desperate for oxygen, but have an issue with removing CO2.
            Not nearly as high-tech or interventional as ECCOR but, for those of us ALSers in respiratory failure, using BiPAP NIV optimises the exchange of gases during the respiratory process, and eliminates higher levels of CO2 at the same time as maximising our O2.
            ​Diagnosed 03/2007. Sporadic Definite ALS/MND Spinal (hand) Onset.
            Eye gaze user - No functional limbs - No speech - Feeding tube - Overnight NIV.

            Comment


              #7
              Earlobe CO2 tests are as accurate as readings obtained from an artery or vein and, unlike the latter two, are quickly and easily analysed in the home, in case anyone has FOMO 😏
              ​Diagnosed 03/2007. Sporadic Definite ALS/MND Spinal (hand) Onset.
              Eye gaze user - No functional limbs - No speech - Feeding tube - Overnight NIV.

              Comment


                #8
                Originally posted by Ellie View Post
                Earlobe CO2 tests are as accurate as readings obtained from an artery or vein and, unlike the latter two, are quickly and easily analysed in the home, in case anyone has FOMO 😏
                Yes earlobe over all others every time

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                  #9
                  Ellieand Christopher my husband had his C02 done today via wrist😱 I wonder why they didn’t do it from earlobe, so much less painful surely xx

                  Comment


                    #10
                    Originally posted by Piglet View Post
                    I wonder why they didn’t do it from earlobe, so much less painful surely
                    Yikes, it must have been bad, your poor husband, not a good day for him...

                    I've had a few wrist ABGs, none painful. I've had my earlobe butchered.

                    All depends on how skilled the medic is.
                    ​Diagnosed 03/2007. Sporadic Definite ALS/MND Spinal (hand) Onset.
                    Eye gaze user - No functional limbs - No speech - Feeding tube - Overnight NIV.

                    Comment


                      #11
                      Originally posted by Piglet View Post
                      Ellieand Christopher my husband had his C02 done today via wrist😱 I wonder why they didn’t do it from earlobe, so much less painful surely xx
                      Piglet as Ellie said it really does depend on the skill of the medic. That's why when having it from the wrist last time I asked if they were good at it (as i know how painful it is when they get it wrong and keep jabbing as there is a major nerve running right by). I have very big ears so there is plenty to aim at there.

                      If it causes pain in the wrist then the medic isn't as good as they should be.

                      Its like at my local hospital there is a ward phlebotomist with purple hair. If you get her you are onto a winner. I was in about a year ago and they had used up all the catheter sites for one reason and another, having to put bigger ones in for different things. The nurses on the ward couldn't sort things, the purple haired lady came around the corner and all was good.

                      She also pointed out to them that I had been on the ward for a week and didn't have a wrist band on

                      Comment


                        #12
                        Now I feel guilty. Poor Stephen was complaining about how painful it was and I told him not to be a wimp. Theyve never done it from his ears and they are plenty big enough.
                        😮
                        when i can think of something profound i will update this.

                        Comment


                          #13
                          Originally posted by denise View Post
                          Now I feel guilty. Poor Stephen was complaining about how painful it was and I told him not to be a wimp. Theyve never done it from his ears and they are plenty big enough.
                          😮
                          When I had it done in Newcastle from my wrist the other people on the ward said to me after, "they could have pulled the curtains around so we didn't have to watch". Both my wrists swelled up like muffins.

                          If its good its good. If its bad its really really horrid (due to the nerve position). xxxxxx

                          Comment


                            #14
                            I remember reading underneath the sheets, when it was cold, with a torch and thinking it was hard to breath like that. So hence the carbon dioxide I presume. What I dont get is my cat can climb underneath the duvet for hours and not have a problem. 🤔😸
                            when i can think of something profound i will update this.

                            Comment


                              #15
                              Originally posted by denise View Post
                              I remember reading underneath the sheets, when it was cold, with a torch and thinking it was hard to breath like that. So hence the carbon dioxide I presume. What I dont get is my cat can climb underneath the duvet for hours and not have a problem. 🤔😸
                              Yes under the sheets you had probably increased the levels to maybe something like 1 percent, which would have made it hard to breath.

                              The CO2 will then find the lowest point and flow off the bed like you have spilt some water.

                              I always believed it worked in that way but then I was able to borrow the first of its kind camera which can see carbon dioxide at 4.3 micron (its wavelength).

                              The people from the company that had developed the camera couldn't believe what they were seeing either.

                              CO2 has some amazing benefits which are not being exploited by the medical community at present.

                              Do you remember before Christmas last year, there was a big thing in the news as there was a shortage of CO2 and therefore food manufacturers were worried as CO2 is placed into food packaging to extend it's life as it kills most of the bacteria.

                              The same bacteria are present on your skin and therefore there is the potential to reduce surgical site infections by its use.

                              Its a big elephant in the room.

                              CO2 has been used for years to elongate the shelf life of meat in ships when it is transported.

                              The wound care side of things is something that I am going to try and keep working on because there is a moral reason for it. Patients with long lasting wounds can find life unbearable.

                              Oops, that was getting very serious.

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