Oxygen Administration and SaO2 Monitoring
MONA is a widely used acronym to aid us in remembering our interventions for patients in the Acute Coronary Syndrome or (ACS) algorithm.
- M is morphine sulfate;
- O is for oxygen;
- N is nitroglycerine; and
- A for aspirin.
Like every intervention, we must assess if it’s necessary and safe based on the patient’s condition, rather than just giving something to them because it’s part of an algorithm. Knowing when we need to give Oxygen and when it isn’t necessary based on pulse oximetry is today’s Pass ACLS tip topic.
Patients with chest pain believed to be caused by myocardial ischemia (ACS) and an accurate pulse ox less than 90% should receive oxygen.
Because Oxygen has little demonstrated benefit in patients with normal oxygenation, it can be withheld for patients with an O2 sat > 90%.
Monitoring patient’s oxygen saturation (SaO2) using a pulse oximeter requires a capillary bed with adequate blood flow. The pulse rate shown on a pulse oximeter should match that on the ECG or the patient’s palpated pulse. Conditions such as hypotension, hypothermia, Carbon Monoxide poisoning, and shock can all cause the pulse ox to give inaccurate readings.
Review two common ACLS pre-arrest mega code scenarios.
Regardless of a patient’s oxygen levels before a cardiac arrest, every patient receiving CPR should be ventilated with 100% oxygen. We should use a BVM with a reservoir and supplemental O2 running at 10-15 L/min.
If ROSC is achieved, O2 levels should be maintained at 92-98% saturation along with an end tidal CO2 of 35-45 mm Hg.
Check out the Pod Resources Page for a link to an episode of The Curious Clinicians that discusses the dangers of over oxygenation.
For additional FOAMed Podcasts, visit ConveyMed.io .
