Analgesic ladderWorld Health Organisation approach to pain
relief, realised by three stages, until relief occurs:
|1||Peripherally acting drugs||Aspirin, Paracetamol, NSAIDs|
|2||Weak opioid - with or without non-opioid
|3||Strong opioids||Morphine, Fentanyl
APGAR scoreA method to quickly assess the health of newborn children,
immediately after birth.
|Appearance||Blue or pale all over||Blue at extemities; pink body
||No cyanosis; body and extremities pink|
|Grimace||No response to stimulation||Grimace/feeble cry when stimulated
||Cry or pull away when stimulated|
|Activity||None||Some flexion||Flexed arms and legs which resist extension|
Scores less than 4 are critically low; 4 to 6 are fairly low; above 6 are normal.
Arterial Blood Gases
Checking patient physiology during:
Wirral University ||
Resuscitation Council ||
- Respiratory compromise
- Post cardiopulmonary arrest.
- Evaluation of interventions eg, ventilation, respiratory stimulants.
- Comparison between pre and post operative variables.
Arterial lineAn intra-arterial catheter
(over a needle) placed in a peripheral artery, such as the radial, axillary,
femoral, brachial, or pedal.
Bi Spectral IndexA 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.
Blood glucose (BM) monitoringBlood glucose
measurement is commonly referred to as 'BM' testing, after 'Boehringer Mannheim', the
German pharmaceutical company (now named 'Roche').
Bottle colour codes
BM testSee Blood glucose monitoring
Blood pressurePressure 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.
rate (per min)
CapnographyThe 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 value||Description|
|Hyperventilation: respiratory alkalosis||< 35 mm/Hg|
|Normal range||35-45 mm/Hg (5%)|
|Hypoventilation: respiratory acidosis||> 45 mm/Hg|
Paramedic notes ||
End Tidal CO2 ||
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
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.
Central venous pressurePressure 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.
ElectrocardiagramRecording 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
Fluid balance Details
Fluid lossesUrine output of normal
adult is 50 ml/hour. Normal daily fluid exchange of 70 kg man is 3 litres.
Hb testingTesting Haemoglobin levels in the
- 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
|Produces decreased end tidal CO2.
Lidco monitorLidco plus is a
haemodynamic Monitor, providing continuous, reliable and accurate assessment of the
haemodynamic status of critical care and surgical patients.
Motor scoreMeasurement 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
OliguriaDeficient secretion of urine.
RecoveryThe provision of
critical evaluation and stabilisation of the post-operative patient, and to
anticipate and prevent complications resulting from anaesthesia or surgery.
Sedation scoreMeasurement 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
Thromboelastography (TEG)A test of the
efficiency of blood coagulation, platelet function, clot strength, and fibrinolysis.