Assessments Flashcards
(29 cards)
Perfusion definition
The ability of the cardiovascular system to provide tissues with an adequate oxygenated blood supply to meet their functional demands at the time, and to effectively remove the associated metabolic waste products
Adequate perfusion
Warm/pink/dry
Pulse 60-100
BP >100
Alert and oriented
Borderline perfusion
Cool/pale/clammy
Pulse 50-100
BP 80-100
Alert and oriented
Inadequate perfusion
Cool/pale/clammy
Pulse <50, >100
BP 60-80
Alert and oriented or altered conscious state
Extremely poor perfusion
Cool/pale/clammy
Pulse <50, >110
BP <60
Altered conscious state or unconscious
When assessing the pattern of injury, the patient can be considered to have a significant blunt head injury in the setting of blunt head trauma with and of the following:
>5 minutes LOC Head # or skull # Emesis >1 Neurological deficit Seizure activity
Normal respiratory status
Calm, quiet Clear steady sentences Usually quiet, no wheeze 12-16 Regular even cycles Normal chest wall movement Pulse 60-100 Warm/pink/dry Alert and oriented
Mild respiratory distress
Calm or mildly anxious
Full sentences
Able to cough. Asthma: mild exploratory wheeze. LVF: may be fine crackles at the bases
16-20
Asthma: slightly prolonged expiratory phase
Slight increase in normal Chest wall movement
Pulse 60-100
Warm/pink/dry
Alert and oriented
Moderate respiratory distress
Distressed or anxious Short phrases only Able to cough. Asthma: expiratory +/- inspiratory wheeze. LVF: crackles at bases to midzone >20 Asthma: prolonged expiratory phase Marked chest wall movement +/- accessory muscle use Pulse 100-120 Pale and sweaty May be altered conscious state
severe respiratory distress
Distressed,anxious, fighting to breath, exhausted, catatonic
Words only or unable to speak
Unable to cough. Asthma: expiratory and inspiratory, may be no sound. LVF: full field crackles, possible wheeze. FBAO: inspiratory stridor
>20 or bradypnoea (<8)
Asthma:prolonged exploratory phase
Marked chest movement with accessory muscle use, intercostal retraction +/- tracheal tug
Pulse: >120, bradycardia late sign
Pale and sweaty +/- cyanosis
Altered conscious state or unconscious
Trauma time critical - actual
HR <60 or >120 RR <10 or >30 BP <90 O2 <90 GCS <13
Trauma time critical guidelines - potential
All penetrating injuries (except isolated superficial limb injuries)
Blunt injuries
-serious injury to a single body region such that specialised care or intervention may be required or such that life, limb or long term quality of life may be at risk
-significant blunt injuries involving more than one body region
Specific injuries
-limb amputation
-suspected SCI or spinal #
-burns >20% tbsa or ?respiratory tract burns
-high voltage burn injury
-serious crush injury
-major compound # or open dislocation
-# to 2 or more of femur/tibia/humerus
-# pelvis
Trauma time critical guidelines - emergent
Mechanism -motor cyclist impact >30km/he -high speed MCA >60km/he -pedestrian impact -ejection from vehicle -prolonged extrication -fall from height >3m -struck on head by object falling >3m -explosion And comorbidities -age >55 -pregnant -significant underlying medical condition
Medical time critical guidelines - actual
Moderate or severe respiratory distress
Oxygen saturation <90% RA/<93% supplemental o2
Medical time critical guidelines - emergent
- ACS
- acute stroke
- severe sepsis including meningococcal disease
- possible AAA
- undiagnosed severe pain
- need for possible hyperbaric treatment
- hypothermia/hyperthermia
Critical illnesses requiring 100% O2
SpO2 <85% Cardiac arrest Major trauma / head injury Carbon monoxide Shock Severe sepsis Anaphylaxis Decompression illness Status epilepticus
sepsis criteria
2 or more of the following: Temp >38 or <36 HR >90 BP <90 RR >20
anaphylaxis criteria
sudden onset of symptoms (minutes to hours)
two or more of R.A.S.H with or without confirmed antigen exposure
R = respiratory distress
A = abdominal symptoms
S = skin/mucosal symptoms
H = hypotension (or altered conscious state)
OR
isolated hypotension (<90) following exposure to known antigen
modifying factors for hypovolaemia fluid administration
SCI, 500ml bolus
chest injury, rx TPT
penetrating trunk injury, accept carotid pulse & tx
uncontrolled external haemorrhage
GI haemorrhage, consider lesser volumes and accept BP of 80-100
Newborn values
<24hours Weight 3.5kgs HR 110-170 BP >60 RR 25-60
Small infant values
<3 months old weight 6kgs HR 110-170 BP >60 RR 25-60
Large infant values
3-12 months Weight 8kgs HR 105-165 BP >65 RR 25-55
Small child values
1-4 years
Weight
- 1 year = 10kg
- >1 year old = age x 2+8 =weight
HR 85-150
BP 70
RR 20-40Medium child values
5-11 years
Weight
- 5-9years = age x 2 +8 = weight
- 10-11 years= age x 3.3 = weight
HR 70-135
BP >80
RR 16-34
