8-9
is expelling free air.
- In emergency conditions, use a one-way Heimlich valve instead. Cut a finger off of a latex glove. Fasten
it as air-tightly as possible over the end of the tube: insert the free end of the chest tube inside the open
end of the glove finger and tape the glove finger around the tube. Cut a 2 cm slit in the closed end of the
glove finger. This will allow air to escape, but the glove finger will collapse on inspiration and prevent air
from entering the lung. This will also collect blood draining from the chest tube. - Place Vaseline-impregnated gauze around the tube at the incision site, cover over that with 4x4 gauze
and tape in place. The Vaseline gauze will prevent air leaks. - If the patient’s condition does not improve, or deteriorates, the placement of the tube is suspect and it
should be checked thoroughly for proper placement, or repositioned. - Other considerations: Antibiotics- load with 1 gm ceftriaxone (Rocephin) IM or IV or similar broad-
spectrum antibiotic for all chest tubes inserted in the field.
What Not To Do:
Do not insert a chest tube if a tension pneumothorax is suspected and the patient is rapidly deteriorating—
perform a needle thoracostomy instead for rapid relief.
Do not reposition or remove and replace a suspect tube if the patient shows signs of a repeat tension
pneumothorax. Perform a second needle thoracentesis, then insert a second chest tube.
Procedure: Pulse Oximetry Monitoring
18D Skills and Training Manual, Reviewed by COL Warren Whitlock, MC, USAWhat: Assess oxygen saturation using a pulse oximetry device.
When: There are three major reasons to use pulse oximetry:
a. To assess the current status of oxygenation of the blood and the need for supplemental oxygen.
b. To monitor patient’s oxygenation continuously when there is a risk of respiratory failure.
c. To monitor pulse rate if there is no better monitoring capability available.
What You Need: A commercial pulse oximeter.
What To Do:
- Understand the principles that make pulse oximetry possible: Pulse oximeters represent the percent of
oxygen bound to hemoglobin (oxygenated blood – bright red; poorly oxygenated – dark red), by
measuring the transmission of red and near infrared light through arterial beds. Hemoglobin absorbs red
and infrared light waves differently when it is bound with oxygen (oxyhemoglobin) versus when it is not
(reduced hemoglobin).
Oxyhemoglobin absorbs more infrared than red light and reduced hemoglobin absorbs more red
than infrared light. Pulse oximetry reveals arterial saturation by measuring this difference. The
pulse oximeter probe contains a sensor and a light source, and is usually packaged in a clip
or flat wrap that can be attached to a source of good capillary perfusion. One side (light source)
emits wavelengths of light into the arterial bed and the other side (sensor) detects the presence
of red or infrared light. - Select a site: The probe is normally placed on the finger or toe of an uninjured limb in an adult, or on
the ear of an infant or small child. - Understand appropriate and inappropriate readings for pulse oximetry:
a. Normal SaO 2 (oxygen saturation) of hemoglobin is 93% or greater.
b. Levels below 90% usually indicate insufficient oxygenation of the blood.
NOTE: These patients need supplemental oxygen or evaluation of their ventilation or both. - Recognize that certain poisons can displace oxygen, saturate hemoglobin and produce FALSE normal
pulse oximetry readings. True oxygen saturation is LOW with carbon monoxide (carboxyhemoglobin) or