The rising number of COVID-19 cases prompted me to create this explainer video on how to use the pulse oximeter correctly. The normal oxygen saturation (SpO2) of a healthy person is between 95 - 100%. It is important to monitor the SpO2 at least daily, better several times a day, for Category 1-2 patients undergoing home quarantine.
The normal oxygen saturation or SpO2 of a healthy person is 95 – 100 %. These numbers generally stay unchanged during moderate intensity exercises and may even increase a little, because one is breathing faster and deeper, resulting in better lung ventilation.
During vigorous short-term exercise, like
in soccer, you may notice a small drop in blood oxygen saturation of about 1 –
2 %. When you stop exercising, the SpO2 will return to your baseline reading quickly.
When a
person complains of shortness of breath, the doctor will take down a medical
history, perform a physical examination and may order some tests. Diseases of the heart, lungs, kidneys or
liver may present with shortness of breath.
The most common functional impairment in patients with lung
disease is impaired gas exchange. In the early stages of many lung diseases, the
oxygen saturation is maintained or is normal at rest, but when the lung is
challenged with increasing demand, like during exercise, the oxygen saturation
may drop.
The 6MWT is used to assess the functional capacity of a
person. The 6MWT is also a simple test
to evaluate gas exchange impairment during exercise. It is widely used, and is considered the gold
standard, to evaluate patients with chronic respiratory disorders like COPD and
ILD. However, it is not feasible to
perform the 6MWT in many office-based practices, which generally, do not have
the flat, straight 30-m corridor required for the test.
There is evidence in the literature, suggesting that the 1MSTST
be used as an alternative to the 6MWT for measuring a person’s functional
capacity and in detecting exercise induced gas exchange impairment. Both tests have a good correlation, and the
advantage of the 1MSTST is that it causes less hemodynamic stress for patients
than the 6MWT. The 1MSTST is well tolerated, easy to perform, understood, and
interpreted; and does not require special hardware.
The mean number of 1MSTST repetitions reported in the literature
achieved ranged from 8 repetitions (patients with stroke) to 50 repetitions (young
men).
The 1MSTST has been validated for use in COPD and ILD of
various aetiologies.
There are many uses for the 1MSTST:
The 1MSTST is used to identify subjects with low exercise
capacity or preserved exercise capacity.
The 1MSTST is used to detect exercise-induced gas exchange
impairment early in the course of ILD, before changes in resting DLco and PaO2,
hence making the early clinical diagnosis of ILD possible. The resting DLco is a specific but an
insensitive predictor of abnormal gas exchange during exercise. The DLco is the
diffusing capacity of lung for carbon monoxide is a measure of the efficiency
of lung gas transfer.
The 1MSTST is used to measure the effectiveness of a
pulmonary rehabilitation programme as an improvement of three repetitions is
consistent with physical benefits.
To perform the 1MSTST place a chair of standard height
(46 cm), without arm rests, against a wall to prevent the chair moving and person
falling during the test. Seat the person upright on the chair with knees and
hips flexed at 90°, feet placed flat on the floor and a hip-wide apart, with
arms held stationary by placing the hands on the hips. The person is asked to
perform repetitions of standing upright and then sitting down in the same
position at a self-paced speed, safely and comfortably, as many times as
possible for 1 minute. The person should not use the arms for support while
rising or sitting. The person is permitted to rest during the one-minute
period.
The patient is given the following instructions:
“The purpose of the test is to assess your exercise capacity
and leg muscle strength. The movement required is to get up from this chair
with the legs straight and sit back continuing the repetitions as fast as
possible within one minute. I will give you the countdown ‘3, 2, 1 Go’ as an
indication to start and I will tell you when we are at the 15 remaining
seconds. If required, you can make a break and resume the test as soon as
possible”.
The patient should be able to perform a minimum of 5
repetitions.
The SpO2 and heart rate are noted before and immediately after
the 1-minute test. The SpO2 and hear
rate are noted for a further 1 minute following the test, during recovery, as oxygen
desaturation can continue for up to a minute after stopping the test. The number of sit-stand repetitions are
recorded for the first 1 minute of the test.
In early lung disease, a person at rest, may have a normal
SpO2 of 95 – 100 %. However, during
exercise the SpO2 may drop because of increased oxygen demand and the presence
of impaired gas exchange in the diseased lungs.
POSITIVE TEST. A SpO2
drop of 3% or more is considered a positive test. A positive test may indicate the presence of
lung disease which requires medical attention.
DO NOT perform the 1MSTST in the following situations.
1. When the resting SpO2 is already abnormal at 94% or less.
2. When the person is immobile or using walking aids.
3. During advanced pregnancy.
4. Following recent abdominal surgery or heart attack.Fo
F STOP the 1MSTST when you notice the following:
1. Feeling faint or giddy.
2. Vision becoming dim or blur.
3. SpO2 falling more than 3% from baseline. (Calculate the value before starting the test. Example: when the resting SpO2 is 96%, stop
the test when the SpO2 fall to 93% or lower.)
4. Sensation of breathlessness which is severe or unbearable.
5. Occurrence of chest pain
You MUST CONSULT a doctor when the test is positive.
The 1MSTST is currently being evaluated for use in
respiratory illnesses other than COPD and ILD.
The IMSTST is being used in some EDs or emergency departments to quickly identify exercise induced oxygen desaturation caused by lung disease, so a decision can be made regarding patient discharge, with or without enhanced monitoring, or hospitalisation.
Is There Life after Death?
Hello. I am Dr Leong a consultant
chest physician.
Is there life after death? This is a very pertinent question, as death
is the only thing that is guaranteed in life.
Many of my patients are concerned but will not bring up the matter to
discuss.
Investigating this subject often
leads to the discovery of spiritual truths.
I found my answer in the Bible and the answer is unique.
Today I wish to share with you my
answer.
Let’s begin.
IS THERE LIFE AFTER
DEATH?
The answer is Yes.
HOW DO I KNOW?
I have seen people in trance. I have seen a person in his 50’s dance, summersault and behave like a monkey. I have seen people walk on fire. I have seen people having their mouths, bodies pierced by sharp objects. While in trance, a person is influenced and empowered by spirits.
I have heard of ghost stories from close friends who had seen and heard the voices of spirits.
There are published photos of ghosts which had been scrutinised and certified authentic.
There are people who had near-death experiences describing out of body experiences. They recall hearing and seeing doctors and nurses doing resuscitation on them.
There are clairvoyants who are able to communicate with spirits.
While in school, I experienced the ouija board where invited spirits can move objects on the board and answer questions.
I hear of exorcism by priests. I have heard how a person’s life has been turned around after the departure of evil spirits.
The supernatural exists whether we want to believe it or not. Medical science has difficulty disproving it. The Bible says spirits exist.
WHAT IS LIFE AND WHAT IS
DEATH?
A person is alive when he is breathing and has a heartbeat. And a person is considered dead when the heart has stopped beating and he is no longer breathing.
HOW DID LIFE COME ABOUT? DID SOMEONE CREATE LIFE?
I am inclined to believe that man is created by a superior being.
The Big Bang theory attempts to explain the creation of the universe and evolution. But the theory is not able to explain how humans get their first DNA sequence and how the first living cell came about.
I believe man is created by God for eternity. Yes, created for eternity.
WHAT IS THE PURPOSE OF
LIFE ON EARTH?
Most of us journey through life with the purpose of sustaining our own lives. We work hard, make money to purchase what we need like shelter, food, security and health. With extra money we purchase what we want too.
My purpose in life is to worship and maintain a relationship with God while also caring for the earth and fellow human beings by using my talents and gifts. In turn, God will provide the ways and means of sustaining my life.
God loves us. We need not worry too much about the future as He is in control of our final destiny.
IS LIFE BOTH PHYSICAL AND
SPIRITUAL?
I have both a physical body and a spirit living inside me. When I die it is my physical body that goes into decay, whereas the spirit lives on. When Jesus, my saviour, comes the second time my spirit will inherit a new resurrected body.
2000 plus years ago, Jesus was crucified on a cross and died. On the 3rd day he rose from the dead. Jesus conquered death. He was seen with a resurrected body that can go through walls. He was on earth for 40 days before his ascension to heaven.
Jesus sets the eternal hope for believers. A future without pain, sorrow and disease.
WHAT WILL HAPPEN AT THE
MOMENT OF DEATH?
My body will fail and stop working one day from illness, a fatal accident or old age. My soul and spirit will separate from my body and live on. They will be lodged in a place known as the “realm of the dead” which is neither heaven nor hell. While at this place the experiences between Jesus believers and non-believers are different. One is pleasant, like in paradise, while the other is not. My spirit will await the Rapture or the Second Coming of Christ when I shall be restored with a glorified resurrected body.
HOW IS SIN AND SPIRITUAL DEATH RELATED?
Sin came about because the first man disobeyed God by eating the forbidden fruit from the Tree of Knowledge of good and evil. When a man with unforgiven sin dies, his spirit is destined to die. However, hell was initially created by God for Satan and the fallen angels and not for man.
God loves us so much that he continues to try all possible ways to win us back to him. His way of saving us is spelt out in the Gospel message. Jesus conquered death and gives the hope of eternal life to all who believes in Him.
My sins are forgiven when I accepted Jesus Christ as my Lord and Saviour. This gift of love, grace and mercy from God is made possible through faith in Jesus Christ. This gift is free. Salvation is not a reward earned by doing good or charitable works.
IS ETERNAL LIFE A CHOICE
THEN?
Man’s eternal destination is either heaven or hell. This destination decision is made while we are physically alive on earth. There is no second chance for the spirit to change its mind after physical death.
God seeks justice for all the wrongs I have done in my life. However, He is graceful and merciful and allows me to choose my destiny when I am alive. By putting my faith in Jesus, he forgave my sins, and justified me into righteousness. He redeemed me from spiritual death.
His work of redemption for believers was completed at the Cross. He carried our sins, sacrificed himself at the Cross and cleansed us of sins. He has justified us into righteousness, freeing our spirits from death.
HOW WILL SOMEONE BE
JUDGED AT THE END?
Bodily resurrection will occur for both believers and non-believers of Jesus some time in future. Then the final judgement follows.
The believers in Christ will have their names written in the Book of Life. Their judgement will be on good works and rewards but not spiritual death. The new heaven and new earth will be revealed.
Those whose names are not in the Book of Life will undergo the Great White Throne judgement when the Second Death will be announced. Hell is envisioned like a lake of fire.
WHAT DID I DO TO FOLLOW
CHRIST?
I first studied intently about
Jesus, looking at the evidence of his death and resurrection. When it became
clear that the Gospel story is true, I did the following:
Acknowledge myself as a sinner
deserving to go to hell.
Believe that Jesus Christ, the Son
of God, came to die for my sins.
Confess my sins and believe that
Jesus Christ is the only saviour.
Understand I am saved by His grace
and not by works.
Believe by faith in the
resurrection of Jesus Christ who is alive today.
And receive him into my life and
let him be my Lord and Saviour.
WHAT SHALL I DO BEFORE I DIE?
Be sure I am saved by continuing to
believe in Jesus Christ
Obey God and be ready and live a
holy life.
Worship God and accept His
salvation with gratitude.
Proclaim the Gospel of Jesus Christ
to the world.
Carry out God’s will by serving others in need.
WHAT IS THE ADVICE FOR ANY
PERSON PREPARING FOR THE FINAL EVENT?
Make sure one is saved for eternity
and not fear death.
Do away with anything that promotes
mental images of scary things e.g. horror movies, occult practices, etc.
If fear persists, get professional
help.
Draw up a will.
Consider advance planning and have
advance directives.
Meet up with family members and friends.
The saved have the Holy Spirit, comforter, in their hearts. God has assuring words and is faithful. Understand that God is sovereign and in control of everything.
THANK YOU.
This is how I view life and death as
a doctor after discovering my faith in Jesus.
Thank you.
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