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Maternal Child Health ‹ Child Health Notes ‹ February 12

IHS Child Health Notes

"It doesn’t matter if the cat is black or white as long as it catches mice."

- Deng Hsaio P’ing 1904-1997

This is a page for sharing "what works" as seen in the published literature as well as what is done at sites that care for American Indian/Alaskan Native children. If you have any suggestions, comments or questions please contact Steve Holve, MD, Chief Clinical Consultant in Pediatrics at steve.holve@tchealth.org

Quote of the month

“The future is already here. It’s just not evenly distributed yet.”
William Gibson

Articles of Interest

Pulse oximetry in pediatric practice.
Pediatrics. 2011 Oct;128(4):740-52. Epub 2011 Sept 19
http://pediatrics.aappublications.org/content/128/4/740.abstract

The introduction of pulse oximetry in clinical practice has allowed for simple, noninvasive, and reasonably accurate estimation of arterial oxygen saturation. Pulse oximetry is routinely used in the emergency department, the pediatric ward, and in pediatric intensive and perioperative care. However, clinically relevant principles and inherent limitations of the method are not always well understood by health care professionals. Safe use of pulse oximetry requires knowledge of its limitations, which include motion artifacts, poor perfusion at the site of measurement, ambient light interference, skin pigmentation, nail polish, probe positioning, time lag in detecting hypoxic events, and presence of abnormal hemoglobin molecules.

This review describes the physiologic principles and limitations of pulse oximetry and also discusses normal values, and highlight its importance in common pediatric diseases in which the principle mechanism of hypoxemia is ventilation/perfusion mismatch (asthma exacerbation, acute bronchiolitis, pneumonia) as opposed to hypoventilation (laryngotracheitis, vocal cord dysfunction, foreign-body aspiration in the larynx or trachea).

Editorial Comment

Pulse oximetry is now ubiquitous. Results are so easy to obtain, and come as a “number” that clinicians sometimes forget that pulse oximetry is only a tool and needs correlation with the patient’s clinical condition. Intelligent usage requires an understanding the strengths and the limitations of pulse oximetry. This article provides it. It should be mandatory reading for all clinicians who will care for pediatric patients this respiratory season.

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Locums Tenens and Job Opportunities

If you have a short or long term opportunity in an IHS, Tribal or Urban facility that you’d like for us to publicize (i.e. AAP Web site or complimentary ad on Ped Jobs, the official AAP on-line job board), please forward the information to indianhealth@aap.org or complete the on-line locum tenens form at http://www.aap.org/nach/locumtenens.htm


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	Maternal Child Health ‹ Child Health Notes ‹ February 12 IHS Child Health Notes "It doesn’t matter if the cat is black or white as long as it catches mice." - Deng Hsaio P’ing 1904-1997 This is a page for sharing "what works" as seen in the published literature as well as what is done at sites that care for American Indian/Alaskan Native children. If you have any suggestions, comments or questions please contact Steve Holve, MD, Chief Clinical Consultant in Pediatrics at steve.holve@tchealth.org February 2012 Articles of Interest Locums Tenens and Job Opportunities Quote of the month “The future is already here. It’s just not evenly distributed yet.” William Gibson Articles of Interest Pulse oximetry in pediatric practice. Pediatrics. 2011 Oct;128(4):740-52. Epub 2011 Sept 19 http://pediatrics.aappublications.org/content/128/4/740.abstract The introduction of pulse oximetry in clinical practice has allowed for simple, noninvasive, and reasonably accurate estimation of arterial oxygen saturation. Pulse oximetry is routinely used in the emergency department, the pediatric ward, and in pediatric intensive and perioperative care. However, clinically relevant principles and inherent limitations of the method are not always well understood by health care professionals. Safe use of pulse oximetry requires knowledge of its limitations, which include motion artifacts, poor perfusion at the site of measurement, ambient light interference, skin pigmentation, nail polish, probe positioning, time lag in detecting hypoxic events, and presence of abnormal hemoglobin molecules. This review describes the physiologic principles and limitations of pulse oximetry and also discusses normal values, and highlight its importance in common pediatric diseases in which the principle mechanism of hypoxemia is ventilation/perfusion mismatch (asthma exacerbation, acute bronchiolitis, pneumonia) as opposed to hypoventilation (laryngotracheitis, vocal cord dysfunction, foreign-body aspiration in the larynx or trachea). Editorial Comment Pulse oximetry is now ubiquitous. Results are so easy to obtain, and come as a “number” that clinicians sometimes forget that pulse oximetry is only a tool and needs correlation with the patient’s clinical condition. Intelligent usage requires an understanding the strengths and the limitations of pulse oximetry. This article provides it. It should be mandatory reading for all clinicians who will care for pediatric patients this respiratory season. Return to top of page Locums Tenens and Job Opportunities If you have a short or long term opportunity in an IHS, Tribal or Urban facility that you’d like for us to publicize (i.e. AAP Web site or complimentary ad on Ped Jobs, the official AAP on-line job board), please forward the information to indianhealth@aap.org or complete the on-line locum tenens form at http://www.aap.org/nach/locumtenens.htm