1. Analgesic ladder

    World Health Organisation approach to pain relief, realised by three stages, until relief occurs:

    1Peripherally acting drugsAspirin, Paracetamol, NSAIDs
    2Weak opioid - with or without non-opioid Lidocaine, Codeine
    3Strong opioidsMorphine, Fentanyl
  2. APGAR score

    A method to quickly assess the health of newborn children, immediately after birth.

    AppearanceBlue or pale all overBlue at extemities; pink body No cyanosis; body and extremities pink
    Pulse rateAbsent<100≥100
    GrimaceNo response to stimulationGrimace/feeble cry when stimulated Cry or pull away when stimulated
    ActivityNoneSome flexionFlexed arms and legs which resist extension
    RespirationAbsentWeak,irregular,gaspingStrong,lusty cry

    Scores less than 4 are critically low; 4 to 6 are fairly low; above 6 are normal.
  3. Arterial Blood Gases

    Checking patient physiology during:
    • Respiratory compromise
    • Post cardiopulmonary arrest.
    • Evaluation of interventions eg, ventilation, respiratory stimulants.
    • Comparison between pre and post operative variables.
    Basics || Wirral University || Resuscitation Council || Interpretation || WebMD || Acid/Alkali?
  4. Arterial line

    An intra-arterial catheter (over a needle) placed in a peripheral artery, such as the radial, axillary, femoral, brachial, or pedal.
  5. Bi Spectral Index

    A depth of anaesthesia monitoring system, using the patient's ECG activity to calculate depth of awareness. A hypnotic state measurement scale of 0 (no electrical activity) to 100 (awake) is used. In general anaesthesia, a reading between 40 and 60 is expected.
  6. Blood glucose (BM) monitoring

    Blood glucose measurement is commonly referred to as 'BM' testing, after 'Boehringer Mannheim', the German pharmaceutical company (now named 'Roche').   Overview   ||   Example system
  7. Blood pressure

    Pressure exerted by the blood on artery walls, as it flows through the arteries. Measured in millimetres of mercury by a sphygmomanometer. A typical value for a healthy young adult is 120:80 mm/Hg. The higher reading is the systolic pressure, which is the pressure when the heart is ejecting blood into the arteries. The lower reading is the diastolic pressure, which occurs when the aortic and pulmonary valves are closed, and the heart is relaxed. Blood pressure can also be represented as Cardiac output * Peripheral resistance.
    Intraoperative blood pressure can be lowered by increasing the anaesthetic or volatile agent.

    rate (per min)
    rate (min)
    1 month12090:5035
    1 year11595:5530
    4 years10095:5525
    8 years90100:6020
    12 years85110:6515
    12+ years64-80120:8012
  8. Bloods testing

    Bottle colour codes
  9. BM test

    See Blood glucose monitoring
  10. Capnography

    The monitoring of the concentration or the partial pressure of CO2 in respiratory gases, usually represented as a graph (capnogram) of expired or inspired (rebreathing systems) levels. In healthy persons, the difference between the partial pressures of arterial blood and expired CO2 is small, or nil in children. In some conditions, such as lung disease or some forms of congenital heart disease, the difference between arterial blood and expired CO2 can exceed 1 kPa. Fever and shivering increase CO2 production levels reduce during anaesthesia and hypothermia. Capnography can give warning of situations, such as: hypoventilation, oesophageal intubation, or circulatory failure.

    End tidal CO2 values:
    End tidal valueDescription
    Hyperventilation: respiratory alkalosis< 35 mm/Hg
    Normal range35-45 mm/Hg (5%)
    Hypoventilation: respiratory acidosis> 45 mm/Hg

    Ventilation  ||   Paramedic notes  ||   End Tidal CO2  ||   Example capnograms
  11. CardioQ Doppler monitor

    An oesophageal monitoring device, to guide intravenous fluid management in surgical patients, who are at risk from serious and potentially life-threatening complications, caused by a reduction in circulating blood volume (hypovolaemia), which results from the combined effects of pre-operative fasting, anaesthetic agents, and blood lost during the surgery.

    The CardioQ Doppler system uses a probe, where the oesophagus and descending aorta lie at their closest point, to monitor the flow of blood leaving the descending aorta, in real-time, using ultrasound, allowing the Anaesthetist to quickly detect any reduction in circulating blood volume, and to make the appropriate interventions. The technique of optimising a patient's haemodynamic status in this way, by giving the right amount of the right fluid at the right time, is known as individualized Doppler Guided Fluid Management.

    The CardioQ system is very sensitive to changes in central circulation flow, and provides immediate and accurate measurement.   Manual
  12. Central venous pressure

    Pressure in the right atrium of the heart: measurement of blood filling the right atrium, blood volume, and cardiac function. Is also an indicator of the heart's effectiveness as a pump.   Image
  13. Electrocardiagram

    Recording of the heart's electrical activity. Heart rate can be calculated by dividing 1,500 by the number of small squares between R waves (300/large squares).   More
  14. Fluid balance

  15. Fluid losses

    Urine output of normal adult is 50 ml/hour. Normal daily fluid exchange of 70 kg man is 3 litres.  More
  16. Hb testing

    Testing Haemoglobin levels in the blood.
    • Wash hands, don gloves
    • Wet side of finger with paper, then dry
    • Set gauge to smallest mark
    • Pierce skin
    • Put sharp in sharps bin
    • Wait 1 minute
    • Wipe blood away
    • Place device perpendicular to blood
    • Repository is filled by capillary action
    • Switch on analyser
    • Place sample in analyser atrium

    See also  Biology
  17. Hyperventilation

    Produces decreased end tidal CO2.
  18. Lidco monitor

    Lidco plus is a haemodynamic Monitor, providing continuous, reliable and accurate assessment of the haemodynamic status of critical care and surgical patients.
  19. Motor score

    Measurement scheme to describe a patient's ability to mobilise the lower limbs.
    • 0: Can bend knees and lift legs
    • 1: Can bend knees and slige legs apart
    • 2: Can wiggle toes, but unable to bend knees
    • 3: Unable to move legs
  20. Oliguria

    Deficient secretion of urine.
  21. Recovery

    The provision of critical evaluation and stabilisation of the post-operative patient, and to anticipate and prevent complications resulting from anaesthesia or surgery.   Details
  22. Sedation score

    Measurement scheme to describe a patient's level of sedation.
    • S Normal sleep
    • 0 Awake and alert
    • 1 Drowsy
    • 2 Sedated/difficult to rouse
    • 3 Unrousable
  23. Thromboelastography (TEG)

    A test of the efficiency of blood coagulation, platelet function, clot strength, and fibrinolysis.
    Interpretation   ||   Guideleines