Good morning. I'm sorry I did not get to visit JustAnswer yesterday as I was working all day and I don't have to tell you that the flu season is here. Our 5 clinics each saw over 80 sick kids yesterday from noon to 8 PM, though none of us left until after 9 PM!
Regarding pulse oximeters, I agree with you that pulse oximetry is the standard of care now in pediatrics and while you can't really charge for this test, not having an accurate measurement incurs some liability for sure. I'm afraid your physician supervisor is skating on thin ice when seeing pediatric patients without adequate equipment or treatments for conditions you treat: asthma, newborn exams, RSV, etc. I don't know how aggressive you want to be but I would simply print out articles like that one as well as the recent one comparing RSV treatment here vs the UK (Scottish study) and the management of asthma, including providing an asthma management plan for every patient.
We generally follow the guidelines of this article for RSV, which could apply to any respiratory issue in children (O2 sat of 94% or greater): http://emedicine.medscape.com/article/961963-treatment
We use WelchAllyn pulse ox instruments and they are quite expensive. You might check on Amazon for some of the lower cost units and look at user reviews for the ones for kids to see how they really work as some of them are only $50 or so: Medline Pediatric Digital Finger Pulse Frog Oximeter, etc.
As to the BP cuff, again, using the right size cuff size is imperative, though the error in using too large a cuff (adult) on a kid is in our favor since a large cuff only slightly lowers the reading, while a small cuff dramatically raises the readings and thus is very inaccurate. The width of the cuff needs to be larger than half the circumference of the arm to be accurate; otherwise the BP will be falsely elevated. We see kids labeled at hypertensive all the time due to using a cuff size too small in the increasingly obese kids or athletes with guns for biceps!
Nebulizers are cheap as is generic albuterol and I can't imagine treating kids with wheezing
without that modality in the office, and it is reimbursed by insurers pretty well, so not only standard of care but it pays for itself in one treatment. The tubing and mask/pipe cost $1 so very little overhead!