I joined Nellcor at the turn of the century to be the System Engineer for their OxyMax project. Nellcor sent several project team members to a University in Florida that conducted an "anesthesia for engineers" class. Two highlights for me were (1) standing within touching distance of the head of a patient undergoing open heart surgery and (2) noticing that the medical staff seemed to be ignoring all the machines that went ping, until the pitch of the Nellcor pulse-ox dropped in pitch. At that moment, all of the white coats around the patient stopped what they were doing to look at the pulse-ox. That was powerful evidence that the project I was working on was important.
Dr. Feinstein, it’s great to see another video by you. During my master’s (in biomedical engineering), we learned that pulse oximetry is one of the most important tools for an anesthesiologist. It’s exciting to see a physician confirm this. Can’t wait to see what other videos you have planned!
Welcome back! I'm so happy for your promotion from "volunteer" at the simulation lab to "assistant professor"! Great so see your stories and explanations once again!
It probably doesn't come up very often during surgery, but another limitation of a pulse oximeter is that it can't tell the difference between oxygen and carbon monoxide. A patient with carbon monoxide poisoning may show a normal oxygen saturation when actually they have very low oxygen saturation but very high carbon monoxide saturation.
Wow that was awesome, I’m glad you’re back! I learned a lot, I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy, I really wanted to be a anesthesiologist, Happy Anesthesiologist physician week! That was a awesome video
Hey Dr. Feinstein! Thanks for covering this hot topic. It would be great if you could also cover some of the statistics behind how pulse oximeters are tested. Only 66% of readings have to fall within the Arms for a device to be considered accurate and thats why pulse oximeters are not diagnostic. There needs to be a range of accuracy because the devices are tested on a range of people, and accuracy is based on the statistics. Also, some cautions about off label use is important here. Since the accuracy is based on statistics if you dont use the device the way it was intended, the performance data and accuracy specs dont mean anything. The folks at the Bickler lab at UCSF are doing really good and meaningful work on the topic for industry and the FDA. Might be good to do a collab with them? Thanks for talking about my products 😊
It was geate to hear you say im a pediatric anaesthetist (im british and judt feels wrong to say anesthesiologist🇬🇧🏴 😂) but i take that means your now a consultant (🧐🇺🇲attending) now having finished fellowship- well done 🎉🎉
I’ve had 19 surgeries! So it’s a walk in the park for me! Most of my anaesthetists ( yes I’m using the Irish term) had no problem with me having my toe nail polish on! (I know to always have my finger nail polish off) Now one anaesthetist had a major issue with my toe nail polish which lead to a hospital wide hunt for some acetone! For context all of my surgeries were axilla and groin all done multiple times, sometimes both at once! The time the anaesthetist raised hell was when I was having a minimally invasive reconstruction of the axilla due to having HS! How do you feel about patients coming in with toe nail polish? And are there certain areas that are being worked on where you would 100% say no to toe nail polish?
An attending told me about 2 weeks ago about how some patients with hemoglobin variants can also have unreliable readings during anesthesia, I guess because these devices are calibrated with normal hemoglobin A in mind.
I always look forward to your videos. They have helped me a lot in the past. Even having you communicate with me directly when I was nervous about upcoming surgeries. Since the last time we contacted each other, I have had a diagnosis of IPF. My saturation levels average between 94 to 96%. How does that effect anaesthesia for me and breathing support while I am under. Could this be a subject for a video?
So glad to see u publish another video!!, i missed you. If theres alot of factors that could influence pulse oximiters on the finger then why is the practise to placeit on the finger still used alot, wouldnt it be more effective to slowly transition away from using pulse oximetry on the finger to the nose or earlobe as common practise for anaethesiolgists
UA-cam Steve Mould has a video where he investigates reading heart rate woth cameras, working off the same principal as the pulse ox meter. It’s pretty interesting.
Wondering if you could make a video on alternate routes of med admin in peds? I work as a paramedic and we often use IO and IN and I’m wondering how much this is used in you setting?
One way to get a low or no reading can be if the person has Raynaud's. I have Atypical Raynaud's (just one hand) and if my hand is too cold you will get no reading.
Hello there. First time listener and veterinary anesthetist. Glad I found you! Was wondering if in bipedal anesthesia, if you typically place your patients on a ventilator? At my facility we usually do not routinely due to reduced cardiac output, esp in compromised patients. Thoughts?😀
I bought one for home use. A few years ago, I tested positive for Covid, despite having had every vaccine and booster. My oxygen read 88, so I called my doctor’s office with the info. They said, go right to the ER, 88 is way too low! I did as I was told, and received IV antibodies. Paxlovid wasn’t an option because of other meds I take. P.S. I had an arterial blood test back in 2000 when I had a syncope while driving! The whole cardiology team came into my cubicle to tell me I’d had a cardiac arrest. They said the arterial test can determine it. Anyway, they were all giddy at my expense because they determined that I have Brugada Syndrome, which they’d never seen outside of a textbook!
@@felixcat4346i don't think there's a clear explanation, but some patients report tasting something (metallic? Can't remember) with propofol injections.
I joined Nellcor at the turn of the century to be the System Engineer for their OxyMax project. Nellcor sent several project team members to a University in Florida that conducted an "anesthesia for engineers" class. Two highlights for me were (1) standing within touching distance of the head of a patient undergoing open heart surgery and (2) noticing that the medical staff seemed to be ignoring all the machines that went ping, until the pitch of the Nellcor pulse-ox dropped in pitch. At that moment, all of the white coats around the patient stopped what they were doing to look at the pulse-ox. That was powerful evidence that the project I was working on was important.
So happy you're back. Missed you!🌷
Dr. Feinstein, it’s great to see another video by you. During my master’s (in biomedical engineering), we learned that pulse oximetry is one of the most important tools for an anesthesiologist. It’s exciting to see a physician confirm this. Can’t wait to see what other videos you have planned!
Glad to see your back! Thanks!
Welcome back! I'm so happy for your promotion from "volunteer" at the simulation lab to "assistant professor"! Great so see your stories and explanations once again!
7:03 I still love the tidbit from one of your videos about increasing the temperature during pediatric cases to prevent hypothermia.
Good to see you back. Excellent information, thank you for covering this.
It probably doesn't come up very often during surgery, but another limitation of a pulse oximeter is that it can't tell the difference between oxygen and carbon monoxide. A patient with carbon monoxide poisoning may show a normal oxygen saturation when actually they have very low oxygen saturation but very high carbon monoxide saturation.
Great video Doctor! I am a CNA in a cardiac unit and you've given me some insight I can add to my work. Thank you!
Wow that was awesome, I’m glad you’re back! I learned a lot, I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy, I really wanted to be a anesthesiologist, Happy Anesthesiologist physician week! That was a awesome video
You have been missed for several months i was affraid that you lost motivation to making UA-cam videos . Keep it coming 🔥
Welcome back! We've missed you.
Grandpa, the bloggers you follow have finally been updated!
Thank you so much for all of your videos. I am.
Playing catch up but I so enjoy every one of them.
YOU’RE BACK WOOOOOO
Hey Dr. Feinstein! Thanks for covering this hot topic. It would be great if you could also cover some of the statistics behind how pulse oximeters are tested. Only 66% of readings have to fall within the Arms for a device to be considered accurate and thats why pulse oximeters are not diagnostic. There needs to be a range of accuracy because the devices are tested on a range of people, and accuracy is based on the statistics. Also, some cautions about off label use is important here. Since the accuracy is based on statistics if you dont use the device the way it was intended, the performance data and accuracy specs dont mean anything. The folks at the Bickler lab at UCSF are doing really good and meaningful work on the topic for industry and the FDA. Might be good to do a collab with them? Thanks for talking about my products 😊
It’s always fun to watch your videos
It was geate to hear you say im a pediatric anaesthetist (im british and judt feels wrong to say anesthesiologist🇬🇧🏴 😂) but i take that means your now a consultant (🧐🇺🇲attending) now having finished fellowship- well done 🎉🎉
my wife has missed seeing your videos. has learned alot from you
I see a new Max Feinstein and I press 👍
We missed you!
Thank you! So helpful.
Welcome back!
Max,
It's great to see you again!! Are you done with your fellowship?
I’ve had 19 surgeries! So it’s a walk in the park for me! Most of my anaesthetists ( yes I’m using the Irish term) had no problem with me having my toe nail polish on! (I know to always have my finger nail polish off) Now one anaesthetist had a major issue with my toe nail polish which lead to a hospital wide hunt for some acetone! For context all of my surgeries were axilla and groin all done multiple times, sometimes both at once! The time the anaesthetist raised hell was when I was having a minimally invasive reconstruction of the axilla due to having HS! How do you feel about patients coming in with toe nail polish? And are there certain areas that are being worked on where you would 100% say no to toe nail polish?
An attending told me about 2 weeks ago about how some patients with hemoglobin variants can also have unreliable readings during anesthesia, I guess because these devices are calibrated with normal hemoglobin A in mind.
Would you consider doing a video on the mechanism of action and uses for Suzetrigine?
Nice video, thanks!!
I always look forward to your videos. They have helped me a lot in the past. Even having you communicate with me directly when I was nervous about upcoming surgeries. Since the last time we contacted each other, I have had a diagnosis of IPF. My saturation levels average between 94 to 96%. How does that effect anaesthesia for me and breathing support while I am under. Could this be a subject for a video?
So glad to see u publish another video!!, i missed you. If theres alot of factors that could influence pulse oximiters on the finger then why is the practise to placeit on the finger still used alot, wouldnt it be more effective to slowly transition away from using pulse oximetry on the finger to the nose or earlobe as common practise for anaethesiolgists
Pulse ox probes don’t stick very well to earlobes and noses. Fingers also tend to be out of the way from surgical sites, breathing equipment etc.
@@jacobtorris3428 thanks for your reply :)
UA-cam Steve Mould has a video where he investigates reading heart rate woth cameras, working off the same principal as the pulse ox meter. It’s pretty interesting.
god bless you I was really worred
He’s back! I guess you’ve been busy! 😅😊
Wondering if you could make a video on alternate routes of med admin in peds?
I work as a paramedic and we often use IO and IN and I’m wondering how much this is used in you setting?
We missed you, Dr. Feinstein!
One way to get a low or no reading can be if the person has Raynaud's. I have Atypical Raynaud's (just one hand) and if my hand is too cold you will get no reading.
He protecc
He attacc
But more importantly, he bacccc
Woohoo
What about capnography as measure.
Hello there. First time listener and veterinary anesthetist. Glad I found you! Was wondering if in bipedal anesthesia, if you typically place your patients on a ventilator? At my facility we usually do not routinely due to reduced cardiac output, esp in compromised patients. Thoughts?😀
Add: we don't routinely paralyze; only as needed. Ex optho, Neuro, some thoracic surgery.
The pulse oximeter sounds like that scanner from the Alien movie
Maybe u’ve confused that with the rectal thermometer : P
Dr. Feinstein is back 😁
I bought one for home use. A few years ago, I tested positive for Covid, despite having had every vaccine and booster. My oxygen read 88, so I called my doctor’s office with the info. They said, go right to the ER, 88 is way too low! I did as I was told, and received IV antibodies. Paxlovid wasn’t an option because of other meds I take.
P.S. I had an arterial blood test back in 2000 when I had a syncope while driving! The whole cardiology team came into my cubicle to tell me I’d had a cardiac arrest. They said the arterial test can determine it. Anyway, they were all giddy at my expense because they determined that I have Brugada Syndrome, which they’d never seen outside of a textbook!
Any chance you can make propofol not taste so bad after it's put in IV lol
"What flavor of propofol would you like today? Vanilla, strawberry, or chocolate?" haha
@repro7780 honestly grape or strawberry would be pretty cool
You have tast buds in your arm?
@@felixcat4346i don't think there's a clear explanation, but some patients report tasting something (metallic? Can't remember) with propofol injections.
yo i missed u
Wow, you do still exist! How much coffee did you. have this morning?
Welcome back!