The monitors at Mount Sinai (and at Elmhurst, and at most hospitals) allow you to add a tone to the pulse oximeter waveform (see: plethysmograph). The tone is a simple beep, but as the saturation drops so too does the frequency of that beep. By the time the saturation reaches 92%, the once reassuring beep takes on an unsettlingly low pitch.

I have been turning the volume of the pulse oximeter up during my intubations for the last year or so. There is no data to support this practice, but I am convinced that I recognize hypoxia sooner by employing this simple function of the monitor.

The nuts and bolts:

Step 1: Click the SpO2 box (touch screen)

Step 2: Select “pleth” (e.g. plethysmograph)

Step 3: Turn up the volume. Titrate to the stress level of your intubation.