Allen Test

Determines whether the ulnar artery will supply the hand with enough blood, if the radial artery is blocked with an arterial line. (Done before arterial line insertion.)

Analgesic ladder

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

Step	Description	Examples
1	Peripherally acting drugs	Aspirin, Paracetamol, NSAIDs
2	Weak opioid - with or without non-opioid	Lidocaine, Codeine
3	Strong opioids	Morphine, Fentanyl

APGAR score

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

Component/Score	0	1	2
Appearance	Blue or pale all over	Blue at extemities; pink body	No cyanosis; body and extremities pink
Pulse rate	Absent	<100	≥100
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
Respiration	Absent	Weak,irregular,gasping	Strong,lusty cry

Scores less than 4 are critically low; 4 to 6 are fairly low; above 6 are normal.

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

Arterial line

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

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.

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

Bloods testing

Bottle colour codes

BM test

See Blood glucose monitoring

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.

Age	Heart rate (per min)	Blood pressure	Respiratory rate (min)
1 month	120	90:50	35
1 year	115	95:55	30
4 years	100	95:55	25
8 years	90	100:60	20
12 years	85	110:65	15
12+ years	64-80	120:80	12

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 value	Description
Hyperventilation: respiratory alkalosis	< 35 mm/Hg
Normal range	35-45 mm/Hg (5%)
Hypoventilation: respiratory acidosis	> 45 mm/Hg

Ventilation  ||   Paramedic notes  ||   End Tidal CO2  ||   Example capnograms

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

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

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

Fluid balance

 Details

Fluid losses

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

Hb testing

Testing Haemoglobin levels in the blood.


See also  Biology

Hyperventilation

Produces decreased end tidal CO2.

Lidco monitor

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

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

Oliguria

Deficient secretion of urine.

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

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

Thromboelastography (TEG)

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