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Dr. A. Clark
Dr. A. Clark , Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience:  33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
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Hi Dr. Clark, I just read an article on the importance of pulse

Resolved Question:

Hi Dr. Clark, I just read an article on the importance of pulse ox checks during a newborn exam to screen for cardiac issues. As I've mentioned I work at a family practice office where our pulse ox and BP machine are the same. The BP always reads 20 points higher when we use it on adults. And the pulse ox is never accurate on infants. I've tried to get my physician to invest in a new one or in a pulse ox specifically for Peds pt's but he refuses to pay the money. So, my question is do you think having an accurate pulse ox reading is worth me purchasing one on my own, even though money is tight for me personally? I think I really do want to know how my patient is saturating when they come in, well or sick. And at what pulse ox percentage is a treat to the ER warranted in a baby that has an URI but no distress? Or an asthmatic in no distress? We don't have albuterol on site to provide breathing treatments should they be needed.
Submitted: 3 years ago.
Category: Pediatrics
Expert:  Camille-Mod replied 3 years ago.

Hi,

My name is XXXXX XXXXX I am the Moderator for this topic.Dr. Clark is not available right now, but I have sent him a message to follow up with you here, when he comes back online. If I can help further, please let me know. Thank you for your continued patience!

Camille

Expert:  Dr. A. Clark replied 3 years ago.
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!

Good luck.

Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience: 33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
Dr. A. Clark and 2 other Pediatrics Specialists are ready to help you
Customer: replied 3 years ago.

Excellent advice, as always. And thank you for the articles too! We'll see how it goes.

Expert:  Dr. A. Clark replied 3 years ago.
Good luck!
Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience: 33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
Dr. A. Clark and 2 other Pediatrics Specialists are ready to help you