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We use pulse oximetry on every patient every day in the ICU, but how does this machine actually work and, importantly, how does it fail? This ICU #OnePager reviews the principle of pulse oximetry and the many factors that can cause inaccurate readings: darker skin pigmentation, nail polish, low flow states (ECMO & LVADs), and abnormal hemoglobins (MetHB, COHb, etc). It introduces the important concept of pulse ox lag-time and also shows how the waveform can provide useful physiologic clues about vascular tone/compliance.
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