(Mis)Using Pulse Oximetry : A Review of Pulse Oximetry use in Acute Care Medical Wards

Background: Nurses routinely use pulse oximetry (SpO2) monitoring equipment in acute care. Interpretation of the reading involves physical assessment and awareness of parameters including temperature, haemoglobin, and peripheral perfusion. However, there is little information on whether these clinical signs are routinely measured or used in pulse oximetry interpretation by nurses. Aim: The aim of this study was to review current practice of SpO2 measurement and the associated documentation of the physiological data that is required for accurate interpretation of the readings. The study reviewed the documentation practices relevant to SpO2 in five medical wards of a tertiary level metropolitan hospital. Method: A prospective casenote audit was conducted on random days over a three-month period. The audit tool had been validated in a previous study. Results: One hundred and seventy seven episodes of oxygen saturation monitoring were reviewed. Our study revealed a lack of parameters to validate the SpO2 readings. Only 10% of the casenotes reviewed had sufficient physiological data to meaningfully interpret the SpO2 reading and only 38% had an arterial blood gas as a comparator. Nursing notes rarely documented clinical interpretation of the results. Conclusion: The audits suggest that medical and nursing staff are not interpreting the pulse oximetry results in context and that the majority of the results were normal with no clinical indication for performing this observation. This reduces the usefulness of such readings and questions the appropriateness of performing “routine” SpO2 in this context.

Toward a theory of the architectural subject

The extraordinary event, for Deleuze, is the object becoming subject – not in the manner of an abstract formulation, such as the substitution of one ideational representation for another but, rather, in the introduction of a vast, new, impersonal plane of subjectivity, populated by object processes and physical phenomena that in Deleuze’s discovery will be shown to constitute their own subjectivities. Deleuze’s polemic of subjectivity (the refusal of the Cartesian subject and the transcendental ego of Husserl) – long attempted by other thinkers – is unique precisely because it heralds the dawning of a new species of objecthood that will qualify as its own peculiar subjectivity. A survey of Deleuze’s early work on subjectivity, Empirisme et subjectivité (Deleuze 1953), Le Bergsonisme (Deleuze 1968), and Logique du sens (Deleuze 1969), brings the architectural reader into a peculiar confrontation with what Deleuze calls the ‘new transcendental field’, the field of subjectproducing effects, which for the philosopher takes the place of both the classical and modern subject. Deleuze’s theory of consciousness and perception is premised on the critique of Husserlian phenomenology; and ipso facto his question is an architectural problematic, even if the name ‘architecture’ is not invoked...