Normal Values
Hb (g/L) |
Normal: 70-100
Males: 135-180
Females: 115-160 |
Platelets (x10^9/L) |
Normal: 140-400
Avoid P+V: <30
?NP suction: <50-60
Weight lifting: >100 |
INR |
Normal: 1
Heart Valves: 2.5-3.5
DVT/PE/AF: 2-3 |
INR |
Normal: 1
Heart Valves: 2.5-3.5
DVT/PE/AF: 2-3 |
BP
MABP
CVP |
90/60 - 140/90
70-105
5-15 |
SIRS Criteria |
WCC: <4 or >12
Temp: <36 or >38
HR: >90
RR: >20 or PaCO2 <32
SIRS: 2+/4 above
Sepsis: SIRS+source infection
Sepsis+: Sepsis+Org. Fail |
Neurological Values
ICP (mmHg) |
0-15
TBI target <22 |
CPP |
>60
CPP = MABP - ICP |
Upper Motor Neuron Lesions |
Weakness/Spasticity/Hypereflexia/Primitive Reflexes
Babinski sign |
Lower Motor Neuron Lesions |
Weakness/Hypotonia/Hyporeflexia/Atrophy
Fasiculations |
Sedatives
Midazolam |
Short acting, avoid due to delirium |
Morphine / Fentanyl (Opiod) |
Also analgesic |
Propofol |
Short acting, rapid onset of action, short term sedation |
Dexmedetomidine |
Used for pt who are difficult to wake due to agitation |
Inotropes/Vasopressor
Noradrenaline (mcg/kg/min) |
Vasopressor
(>0.1) |
Adrenaline (mcg/kg/min) |
Vasopressor + Isotrope
(>0.1) |
Dobutamine (mcg/kg/min) |
Inotrope
(5-10, >10 risk of arrhythmias) |
Vasopressin (units) |
Increases BP by increasing renal fluid resorption + peripheral vasoconstriction
(0.01-0.04) |
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MHI precautions
PEEP >10 +/- (FiO2>0.4) |
Airborne or contact precautions |
FiO2 >0.7 |
Pulmonary compliance is low (compliance <40mL/cmH2O) |
Pulmonary bull or lung abscess -> CXR |
MHI Contraindications
Highly infectious respiratory conditions |
High frequency oscillating ventilation (HFOV) |
Severe bronchospasm or gas trapping |
Pneumothorax is present and is untreated (insertion of ICC) |
Frank hemoptysis is present |
MHI - Resp Considerations
Patients WOB |
Accessory muscle use
Paradoxical breathing patterns
|
CVL insertion |
Withhold MHI until CXR -> ptx |
ICCs |
Review swinging, bubbling and drainage prior/after rx |
Broncho-pleural fistula |
D/w ICU consultant |
MHI - Haemodynamics Considerations
Acute PE is present |
BP is low (MABP<60) especially 1) labile BP 2) High vasopressor/inotropic) 3) acute resuscitation phases of septic shock or hypovalemic states |
New arrhythmia (ok if present + controlled) |
MHI - Neurological Considerations
ICP |
Is it being monitored, caution when CPP/ICP is labile |
Cerebral hemodynamics |
Hypocapnia > vasoconstriction > dec. ICP
Hypercapnia > vasodilation > inc. ICP |
EVD |
Should be clamped prior to MHI |
Increase in ICP during MHI |
Hyperventilate > hypocapnia > vasoconstriction > dec ICP |
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Subjective Ax
Heart and lungs: PMHx |
Post Op: nausea, vomiting, light-headedness, pain |
Resp: cough, sputum, wheeze, SOB, smk hx |
PLOF: aids, ex-tolerance/limitation, indoor/outdoor, falls |
SHx: home setup, occupation, children, hobbies |
Objective Ax
Resp: |
Cough, sputum, palpate, auscultation |
Neuro: |
Sensation (light touch, pain), power
UMN: spasticity, babinski, clonus, hyperreflexia
LMN: hypotonia, hyporeflexia, atrophy, fasciculations |
MSK: |
MMT, atrophy |
Function: |
Sitting balance, etc |
Gait: |
As appropriate |
Circulation: |
DVT, Cap refill |
Room Prep
Where are we going/what do we need |
Chair, IV pole, sheet, aid, which side |
Do we need to monitor |
Yes/No - what do we need |
Bed Space |
Wires, chairs, drains |
Attachments |
Drains, monitoring, CVL, art line, EVD?, Femoral art line? |
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