Glasgow Coma Scale
is used to assess level of consciousness after head injury.
Eye=4: verbal stimuli 3, to pain 2
Mouth=5: confused 4, inappropriate 3,
... [Show More] incoherent 2.
arm=6, localize pain 5, withdraw from pain 4, flex to pain 3, extension to pain 2.
8 or less intubate
Changes in CVP can indicates
changes in Fluid balance,
decreased CVp<2 can indicate hypovolemia,
increased CVP>6 can indicate hypervolemia
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Orthopnea
difficulty breathing except in the upright position, CHF patients
General malaise
Electrolyte imbalance - nausea, weakness, headache
Hemiparesis
abnormal posturing, could indicate brain injury.
Miosis
pinpoint pupils
ptosis
drooping of the upper lids
diplopia
blurred or double vision
nystagmus
cyclic movement of the eyeballs
Erythema
redness of the skin
Ecchymosis
subcutaneous hematoma or bruises
Tracheal Deviation: Pulled to Abnormal side
Pulmonary atelectasis, Pulmonary fibrosis, diaphragmatic paralysis
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Tracheal Deviation: Pushed to normal side
Massive PE, Tension Pneumothorax, Neck or Thyroid tumors outside of lung
Flat or Dull sounds
flat- heard over the sternum, muscle or areas of atelactsis,
dull- heard over fluid-filled organs, heart or liver (PE, or pneumonia)
If PaO2 increases with Oxygen therapy
then the patient has a V/Q Mismatch 66- 300 torr
If PaO2 does not increase with Oxygen therapy then
the patient has a shunt >300 torr
Arterial Oxygen Content (CaO2)
Best measurement of oxygen delivered to the tissues,
Normal = 17-20 vol% ml/dL
Mixed Venous Oxygen Content (CvO2)
Total amount of oxygen carried in the Mixed venous blood,
Normal = 12 - 16 vol%,
CvO2 values will decreases when Cardiac output decreases
C(a-v)O2 difference will increases when the CvO2 is decreases and would indicate
decreasing in Cardiac output
Arterial-Venous Oxygen Content Differences
C(a-v)O2
normal :4 - 5 %
Shunt Equation (Qs/Qt)
For every 100 A-aDO2 = 5% shunt,
300= 20% shunt; (5x3) + Normal 5 = 20%
calculating PAO2
(FiO2 x 7) + 10
A-aDO2 = PAO2 - PaO2,
Alveolar-Arterial Oxygen Gradient
P/F Ratio
Normal 380 or greater,
Mild ARDS = Less than 300,
Moderate ARDS = Less than 200,
Severe ARDS = Less than 100,
Arterial catheter with Pressure transducer should be at
- should be at the level of heart,
- if transducer is placed above the heart, reading are lower than actual,
-if transducer is placed below the heart, reading are higher than actual,
PAP inserted through
the jugular or subclavian vein are position in the the pulmonary artery approximately 50cm of catheter is inserted,
if >50cm of catherete is inserted - catheter is curling in the right atrium or right ventricle,
Ballon should be deflated and the catheter withdrawn
PAP normal
25/8, Mean 14
PCWP, pulmonary Wedge Pressure
4-12 mmHg
Left Heart
MAP (systemic Arterial System) Mean Arterial PRessure
120/80
CVP Systemic Venous System (Central Venous Pressure)
2-6 mmHg or 4-12 CmH2O
Normal Cardiac Output (Qt)
4-8 L/min
Normal Cardiac Index (CI)
2-4 L/min [Show Less]