> A pulse oximeter is a device that measures blood oxygen saturation. Sensor
> clips to earlobe or finger.
> Then you know your saturation level and can adjust oxy flow to keep it
good


If anyone is using a pulse oximeter it is important that they have some
understanding of the physiology behind it.
Pulse oximetry is a useful, non-invasive indirect measure of the partial
pressure of
arterial oxygen, but it has limitations.  It utilizes the difference in
infra-red absorption of saturated (oxygenated) and de-saturated
(de-oxygenated) arterial and venous blood.
The sensor has to pick up a good arterial trace to read accurately.  This is
very dramatically influenced by movement and cold (and we know it can be
cold up there!)  Indeed, at times it can be wildly inaccurate.
The sensor reads carboxy haemoglobin the same as oxy-haemoglobin, so you
smokers out there full of carbon monoxide will artificially read a percent
or two higher, while
actually carrying less oxygen.

Oxygen saturation is only an indirect measure of the all-important factor of
arterial oxygen tension.  The normal healthy range is 96-99%.  Decreases
below this represent a very significant reduction in arterial oxygen
carriage.  One medical definition of respiratory failure is a PaO2 of less
than 60 mmHg.  This is reached at an altitude of about 10,000'.  This
usually corresponds to a saturation level of about 90%.  90% sounds pretty
good compared to 96%, but actually represents an alarmingly low arterial
oxygen level.  At around 90 %, small changes in saturation also reflect a
very large change in oxygen level.  Even one or two percent represents a big
difference, and that is well and truly within the error limit of the
machine.

It is well documented in aviation medicine that night vision is
detrimentally affected by hypoxia due to the retinas high oxygen
consumption.  This occurs even at altitudes of 5000'.  I wonder if there is
a similar reduction in the ability to pick up day-time traffic.

Interestingly, the "oxygen above 10,000' " rule does not take into account
density altitude.  This is based on an ISA of 10,000', ie 15 deg C at sea
level.  On a hot summer day of 40 deg at ground level, this is ISA+25, which
equates to an extra 3000' of altitude.  So at 10,000' you're actually
already at a density altitude of 13,000, and starting to get quite hypoxic.
Remember it's the number of molecules of oxygen (the density) that is all
important.

One of the most common symptoms of hypoxia is lack of insight and euphoria.
After a particularly good day's flying when it was 40 degrees on the ground
with thermals up to 14,000' one pilot without supplemental oxygen remarked
"I felt a bit short of breath to start with, but after a while I felt fine!"


Here endeth the lesson.

Dave Long

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