Low SATS, what would you do?

Hello,

It's been a while since I last posted but Leo (5 yr old son) has had a turbulent few months, with his last admission being in November.

He saw his resp. Consultant again on 2nd Jan and we were given salbutamol nebules for a home nebuliser at last. I know this is a controversial move as it can lead to people not being admitted in time, but our consultant believes that we have experienced enough asthma episodes with Leo to know when home treatment is not working. We also have two SATS oximeters so check his SATS before and after his nebuliser.

This is where I have an issue and although I know this forum is not a medical forum so people cannot give medical advice but I am just looking for opinion son what others have experienced or would do in this situation.

Leo's SATS have been hovering around 92-93 the last two days whilst he has been unwell with a cold and an exacerbation of his asthma. He has started yet another course of prednisolone .I. His SATS have gone up to 94-95 after nebuliser and then back down to 93 or so about an hour afterwards. Based on him being quite happy in himself today (much better than the day before), I have just carried on with the nebuliser/inhalers as needed. However, I have just gone and checked his SATS whilst he is fast asleep in bed and they are down to 90. He is labouring slightly but this is normal for him when he is having an asthma episode and it is no worse tonight than it has been over the weekend. But still, I think 90 is low. But he is sleeping peacefully. I am about to give him 10 puffs with his spacer (I think the noise of the nebuliser might upset him at this time of night), so hopefully it will go up.

My husband thinks that it is best just to let him sleep and not to worry as long as we keep checking him (I will sleep with him tonight).

Is 90 too low to be at home? I know they won't usually discharge him until his SATS are at least 96 when he is not he ward but he doesn't seem distressed right now.

Any thoughts would be gratefully received.

I would just like to say that if I thought he was in any danger we would of course take him in immediately, I am just wondering whether, as we are trying to deal with things more at home, we are doing the right thing.

Thanks,

Rebecca

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I think this is something you need to ask a medical professional. Paediatrics is different to adult parameters and we aren't qualified to say. I would suggest contacting out of hours for advice over the phone.

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Well Leo is an enigma as his GP once called him, it's official!! He's just been to see the GP and he was full of beans, jumping around chatting at the top of his voice, so the doctor was highly surprised when he checked Leo's SATS and they were reading at 90!! We put the hyperactivity down to the preds and ventolin, as I'm sure many of you will have experienced the hyper side effects these have in high doses! He did say, however, that if his SATS are 90 or below after inhalers or nebulisers that he must be seen, so I suppose at least I now have a benchmark for Leo, although I have seen him be a lot more poorly with higher SATS than 90. It's such a hard judgement to make.

Now I have to decide whether or not Leo should go to school tomorrow. He is fine in himself but with such low SATS I'm not sure. I feel like a fraud having him home today as he is so 'normal', just the odd cough here and there, yet the numbers don't lye! Argh it is so hard knowing what decisions to make, I just hope one day he grows out of it!!

[yaf_user681_15459]

Hi,

Firstly, sending humungous hugs as I completely empathise with the 'what shall we do' kinda thinking while your child sleeps soundly.

What I will say is that sats go down when you are sleeping so its normal to be lower at night. BUT you need to know what's normal for Leo. What are they when he's well?? And how long do they stay up when he's had salbutamol??

I'm not giving any medical advice hun, just giving you hints of the type of things I think about with Maddie.

All to often we sit in the evening deliberating our next move..donea she need help, do we need out of hours or an ambulance or can we manage at home. Her sats often sit at 92 but that's normal for maddie when she's not 100%.

It really depends on what his norm is hun. Any doubt, call for help. As for school, I'd keep him home. You will only spend the day wondering and worrying. I did the same last week and totally regretted sending her while her O2 was 90 and she was struggling.

Let us know how he is.....

[yaf_user681_15459]

Hi,

Firstly, sending humungous hugs as I completely empathise with the 'what shall we do' kinda thinking while your child sleeps soundly.

What I will say is that sats go down when you are sleeping so its normal to be lower at night. BUT you need to know what's normal for Leo. What are they when he's well?? And how long do they stay up when he's had salbutamol??

I'm not giving any medical advice hun, just giving you hints of the type of things I think about with Maddie.

All to often we sit in the evening deliberating our next move..donea she need help, do we need out of hours or an ambulance or can we manage at home. Her sats often sit at 92 but that's normal for maddie when she's not 100%.

It really depends on what his norm is hun. Any doubt, call for help. As for school, I'd keep him home. You will only spend the day wondering and worrying. I did the same last week and totally regretted sending her while her O2 was 90 and she was struggling.

Let us know how he is.....

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When Leo is not poorly his SATS are usually between 97 and 98 which is wonderful but when he is poorly he struggles really badly when his SATS drop below 94. That is why this time was so different because yes he was suffering and his SATS were low 90s but he wasn't presenting as badly as before and we were managing to make him more comfortable (although not totally better by a long shot) with his nebuliser. I think next time if his SATS are 90 or below even before his nebuliser I will take him to the ward where he has open access, as although we have the nebuliser it is not as effective as the hospital nebuliser as they give him oxygen too which can make a big difference.

Thanks for sharing your experiences with me, it is much appreciated