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Okay, Duncan, what we need to do now is we need to use the pulse oximeter and we place it on your finger right here.

Now, we need to be careful, this is going to measure the percentage of oxygen.

Does it hurt?

It does not hurt, no. It is just a little clip that goes on the end of your finger right there. As you can see, there is a red light in there, that shines through your fingernail. And so what it is looking for is the percentage of oxygen attached to the haemoglobin. Babies will have 100%, or somebody who is hyperventilating will have 100%. Somebody who is having respiratory problems, it will be lower than that. We look for 96 or above, unless somebody has a lung pathology like chronic obstructive pulmonary disease, where we are looking between 80 and 92. So it is important to know the clinical condition and the history of your patient.

Okay, so the pulse oximeter, the red light shines through the fingernail right there, any finger will do. Do not do it on the same side that you use the blood pressure cuff on, because the blood pressure cuff cuts off the blood supply so the saturation is the... Peripheral oxygenation will lower artificially.

Okay. What about things like grease and oil and nail varnish? Will they affect it at all?

They will. If a hand's dirty, the pulse oximeter, the light needs to be able to see through the fingernail. So if there are false nails, it will not be able to see through them. And really it is... You can use feet, you can use toes, but it is good to remove the nail so that the light can see through the fingernail. So the finger must be clean really and unimpeded.

Yeah. This is an adult probe, I take it, because it is quite big if a child wanted to use it. Is there a different thing for a child, children?

Yeah, there are different sizes. For babies, have one that straps around the finger and holds it in place because babies all wriggle a little bit. And then there is various sizes going through stages of child development. We also get an audible beep when your pulse is... Can you hear that? Yeah?

And that is giving us a pulse rate of 76 and your oxygen saturation is at 99%, so it is above the 96 that we need. If your patient falls below any of those parameters, you need to intervene, give oxygen for patients who will need oxygen. If a patient has a saturation that is below 88% then that is an emergency, oxygen needs to be given and they need to get seen in A&E immediately. So SpO2, saturation of peripheral oxygen, that is the measurement that we are doing at the moment. So on top of the readings that we have here, there are a couple of other things we can do. We can hear that the pulse is giving us an audible and we can hear it, but that might not be the full story, we need to feel the pulse. So your radial pulse is where we feel the pulse, radial artery, just on this lateral edge here. The radial bone here, you just press the artery against the bone and just press it until you can feel that pulse and you are looking for the strength of the pulse, the regularity, anything that might be not what you are expecting.

Your pulse is nice and regular, it is good and strong, there is no weakness, it is not thin and thready and it is not bounding as well, so your body is not under stress. The other thing we can do, turn your hand over, is just press your fingernail down for five seconds, it will turn white because you are occluding the blood to the capillaries right there. And then the blood should return and the fingernail should return pink within two seconds. So as soon as you let go, one thousand, two thousand. So there we go, one thousand, two thousand, your capillary refill is within two seconds. If that is lengthened, that means there is some problem with the blood getting through to you.

So we could use that to see whether a bandage is too tight or whether an artery or a vein is occluded due to a fracture or something like that. Does anything else happen? Do you get any colour changes or anything like that?

With the hand?

Yeah. The hand should be nice and pink and warm and the sensation should be present as well. So if there is a problem with the blood flow to the hand, it will turn pale and if this is not rectified, it will turn blue.

Okay, what's that called? If it goes blue, is there a name for that? That is hypoxia.

Lack of oxygen to the tissues, so it needs to be fixed immediately because when there is no oxygen to the tissues, tissues will die.