Personal Blog: Treat the patiënt, not the monitor

It is a well known mantra in the critical care:


"treat the patient and not the monitor"


It means that you should not, and / or can, deal with patients purely on the values ​​of a monitor.

The most important thing is and still remains the patient. What does the patient say of feel, what do parents say about their children, what does the patient look like, how much effort does the patient have to do to get a 'good' saturation (oxygen content)?


The importance of your clinical view and the so-called 'fingerspitzengefühl' the feling that something is not right, while you can not explain what.


In the EWS (early warning score) an extra point is scored if you don't trust the state of your patient

Personally, I have a good example that you should not act on the values ​​of a monitor alone.


I had an evening shift at the emergency department in the Netherlands, it was a busy service as often. That night I worked with a few graduate colleagues and a student-ED nurse who was almost done with her education.

At one point the ambulance came with an elderly lady who was very sick. a reduced mental state, high fever and 'shock' (low blood pressure, high pulse).

Our first thought was: Sepsis / septic shock


Together with the ED student, I did the primairy stabilisation. We connected the patient to the monitor, and a extra peripheral infusion (with a fast-running infusion) was given, with the state of shock in mind. We immediately took blood samples so that it could be sent quickly to the lab. At the request of the physician-assistant, we immediately gave antibiotics.


After we stabilized the patient, the student ED nurse went out of the room to find her supervisor.

At that moment I stood in the room with the doctor, when suddenly one of the senior nurses 'rushed' into the room and shouted that the patient had a low saturation (low oxygen level (85%), whereas she did not show a respiratory (dis) stress during our treatment.

(normal values ​​of oxygen are 95-100% for healthy patients and 90-92% for patients suffering from COPD)

She began trying to get the tongue out of Mrs. 'throat', tried to put a mayo-tube in her mouth, which did not work, but caused a lot of anxiety for the patient (who was stable at the time).

I was given the assignment to give 15 liters of oxygen (per minute) to the patient, and the patient had to be turned directly on her side.

I experienced a huge unrest and panic (with the senior ED Nurse), whereas in my opinion this was not necessary at all. Given that Mw. Had not shown a low saturation the entire period before, and in my opinion this was not the case when the colleague came in.

The 'low saturation' that the patients monitor had shown, which was the reason for the colleague to initiate all these interventions, was probably not a good measurement of the oxygen level.

What the colleague probably dit not realised, that when the value of 85% oxygen was seen, the saturation curve was not good at all, and so it was not a real measurement.

not a good curve = less reliable

good curve = more reliable

The result was that the student and I (wrongly) were told, that we did not notice the "low saturation" and did not take any action. The other consequence was that the patient had a high oxygen content in the blood, which could also have adverse consequences.

It showed me very clearly that you should never take action on the basis of a value alone.