Tue, 20 May 2008|
In this fire EMS training video, Fire Engineering Technical Editor Mike McEvoy discusses determining blood flow in a patient.
I I'd like to talk today about assessing profusion. And there are couple situations where we may be interested in measuring profusion and outpatient. Traditionally we've learned that if you arrive at the scene and an incident and you only able to access an -- -- -- impatient for example. An arm or leg but he could make an assessment on the polls in extremity to determine. What the patient's blood pressures. If we were only to find an arm sticking vehicle when we arrived on the scene and were able to measure -- -- that arm. We can make a presumption that a patient has a systolic blood pressure of a if were able to measure of polls only -- -- artery on -- patient we can make a perception that the patients systolic blood pressure is seventy. If all you can measures of -- a lot of -- -- -- -- the patients to -- -- pressure is -- to -- at least sixty. So that's a method of giving you some information about profusion in a patient. They're a couple other ways that you could actually assess profusion if you're interested in determining the flow laws passed an injury to an extremity. So if for example. We had a fractured leg on her patient. And we wanted to make an assessment of blood flow to the -- continent area beyond the fracture. We could measure. The pulses. This -- to where the -- is an extra. There are two places and what measure. Profusion of peripheral -- one is on the top surface of the book which is called ourselves Peters -- And the measurement of that is done by. Finding the space between the great told the large -- and until next to it and sliding fingers up to about the middle -- -- -- You can actually feel it through this patients stock. So that's called and ourselves -- polls in the presence of that tells you that they want well for the -- The polls behind the ankle on the inside of the leg is the -- to deal pulse. That's a little bit stronger most patients and the polls on the top of the four. Pollsters can be -- polls also would tell you that there's flow. Past the point where you have a fracture injury to an experiment. In the arm you have pulses. -- both of radial side of the arm and on all their side. Look loops around in the hand and he should be able to measure of polls -- your fingertips on both the -- side and on the on the side. That tells me how well in the extremity itself. There -- a couple commercial devices -- also give us. Information about profusion. And I want to talk about those devices because there's actually a way to quantify. What the blood flow -- -- extremity using what's called a profusion index. Profusion index actually tells you about blood flow to the point -- -- senator probe is attached to the patient. One of those machines is the -- -- -- native machine. They -- -- native machine displays a profusion index for a patient. Phillips is another manufacture. Of displays profusion index on their -- -- there and Massimo. Is a machine that displays profusion and we're gonna use to masimo -- senators actually look at profusion and that's on our patient. I'm gonna power up the -- mocked senator -- to go through a display of alarms. Now place the probe on the patients ring finger the ring finger. Should give you the strongest -- mystery signal on patient because it tends to be the finger with the highest blood flow in patients. What we're seeing what massive lot senators -- calibrating to that thing that we put on. And I -- begin to display. Polls and -- oxygen saturation. On the right hand side of the -- there it's actually displaying a diffusion index of -- NASA -- senators on a profusion index of zero to one. The profusion and that's that's normal for a patient is anything above one point four. A profusion and that's less than one point four identifies either an extremity that has very low blood flow or patient. -- was not refusing well perhaps because there in shock. What we'll do with the -- -- -- here is locate the -- has the highest diffusion index. We can and monitoring -- -- -- has the highest profusion index. And make a determination now whether that's changing over time because of blood flow to -- if we had -- -- -- -- fractured. Or perhaps because of blood flow in the patient because -- -- conditions. This is some that many fire departments also measured carbon monoxide patient. There's another -- -- -- which measures. Not only carbon monoxide but measures -- hemoglobin. And because of the software and -- you know. It reports the profusion index and the different fashion -- the bar that we saw on the right hand side in the prevention. We'll place the probe on the patients -- -- here again the thing advocates of the strongest signal. We wait for the machine to calibrate -- -- -- and then displaying the patience polls and has not symmetry. And in this situation we no longer see the bar on the right hand side of the unit report in the profusion acts we actually have to scroll. Through our display. To demonstrate the profusion index in the patient. And in this case you see a number significantly above. One point four which tells us that where this individual. Afloat that -- there -- is beyond what's normal. And the patients profusion. Indicates that he also it is not in shock like state. So any number again about one point four. Is the separation between an extremity that's getting poured blood flow a patient who's not refusing. Numbers below one point four million. Find another site to measure. The saturation and a profusion and that's in the patient or the patient is particularly out. I'm like Mac Voight thanks for watch.