MAKING A DIFFERENCE
It is impossible to remember all of the formulas, mnemonics, conversions, and memory tricks we learned through our eduction and
practice. So this page is dedicated to those jewels of knowledge that keep slipping away from my memory. If you can think of any
I missed, please contact me and I will make sure it slips in here. If you learned it differently, let me know different minds learn
things differently and yours may work better than the one I keep forgetting.
practice. So this page is dedicated to those jewels of knowledge that keep slipping away from my memory. If you can think of any
I missed, please contact me and I will make sure it slips in here. If you learned it differently, let me know different minds learn
things differently and yours may work better than the one I keep forgetting.
Glasgow Coma Scale
Eyes Open eyes
Opens eyes on request
Opens eyes on pain
Fails to open eyes
Verbal Appropriate conversation
Response oriented to month and year
Confused and or disoriented
Inappropriate conversation
Incomprehensible sounds
No sounds
Motor Follow simple directions
Response Removes pain source
Withdraws from pain source
Non-purposeful flexion (decorticate)
Non-purposeful extension
(decerbrate)
No motor response
Osmolarity
Below 275 Hypotonic
275-295 Isotonic
IV Solutions
Isotonic: L.R., D5W, NS
Hypotonic: 1/2 NS, .33NS, D2.5W
(155)
Hypertonic: D5NS, D5 1/2NS, D5LR, D10W
(406)
Osmolarity
(2xSerum Na)+(glucose/18)+(Bun/2.4)
Anion Gap
Na-(Cl+HCO3)=>15
Normal P-R interval 0.12-0.2
Normal QRS 0.04-0.12
"For ACLS Algorithms: This if from my Critical Care Syllabus (NU 403-Med.Surg. Nsg II)" Contributed
by Dr. Hatfield
Mgmt of MI patient: MONA Be A Friend, Please!
Morphine
Oxygen
Nitrates
ASA (within 24 hrs of admission and on discharge)
BB (within 24 hrs of admission and on discharge)
ACE-I or ARB for LVSD (EF <40%)
Fibrinolytic within 30 minutes of arrival
PCI within 90-120 minutes of arrival
VT/VF Algorithms: AAA SCREAM
AAA: Assess the patient first (not the monitor)
Activate Emergency Response
Action- start CPR
SCREAM
Shock at 200 joules(with biphasic defrillator) or 360 (monophasic)
CPR x 2 min.
Rhythm check: if still in VT?VF give...
EPI or Vasopressin IV or IO ( no more meds down the ET tube)
CPR x 2 min. and shock at 200 joules
Antiarrythmic meds: Amiodarone IV/IO
CPR x 2 min. and shock at 200 joules
Antiarrythmic meds: consider Lidocaine in Amio. not effective
CPR x 2 min. and shock at 200 joules
Antiarrythmic meds: consider Mag Sulfate IV/IO but only if Mg is low or pt in Torsades de Pointes
If pt is acidotic: NaHco3 (draw ABG's)
If pt converts out of VT/VF: hang a drip based on the med bolus used (Amio or Lidocaine)
Asytole Algorithm:
"maybe we should give some CEA"
CPR
Epi or Vasopressin
Atropine
Bradycardia Algorithm:
"Pacing always ends danger"
Pacer transcutaneous
Atropine
Epi
Dopamine
If the patient is resuscitated, considered differential diagnoses (what caused the code to occur); order CXR, lab work, 12 lead EKG and
speak with the family.
FYI: 12 lead EKGs are recommended standard equipment in all mobile pre-hospital transportation vehicles. Guidelines also state
that fibrinolytics can be administered to chest pain victims if arrival time to ED is going to be over 60 minutes from onset of chest pain
(RN, May 2001, pg. 75).
Pulseless Electrical Activity (PEA)
Treat the cause first!
Causes: Remember 5 “H's” and 5 “T's”
Hypoxia* Tension Pneumothorax
Hypovolemia* Tamponade (Cardiac)
Hypothermia Tablets (drug overdose)
Hyper/hypokalemia Thombosis, coronary (ACS)
Hydrogen ion -acidosis Thrombosis, pulmonary (embolism)
*Most common causes
Algorithm “P-E-A”:
Possible causes-always give 500 cc bolus of fluid since hypovolemia is common cause.
Epinephrine 1 mg IV q 3-5 minutes
Atropine 1 mg IV q 3-5 minutes
Consider transcutaneous pacing
Dopamine after rhythm and pulse returns to treat BP
Parkland Burn Formula
(%TBSA burn area x Pt. Wt. In Kg ) divided by 4 = ml /hr
Children and infants require additional fluid beside the calculated fluid resusciation. The maintenance fluid is D5LR
( because of risk of hypoglycemia)
Maintenance formula: 4cc/kg/hr for the first 10kg
plus 2cc/kg/hr for 10-20kg
plus 1cc/kg/hr for over 20kg
IV Fluids infusion factor
( Total amount (ml) x your drop factor ) devided by total time in min. = drops/min
Cockcroft-Gault Equation for Calculating Creatinine Clearance
Creatinine clearance= (140-age) x weight (kg)
serum creatinine (mg/dl) x 72 ( x 0.85 for women)
Note: Special considerations- for patients over the age of 90 years use 90 years old for age
- for obese patients, use the ideal body weight:
Men=50kg + 2.3 kg for every inch over 5 feet
Women+ 45.5kg + 2.3kg for every inch over 5 feet
EKG Changes in MI
Site of
Infaraction Changes seen Possible occlusion
Large anterior V1-V6: ST segment
Wall elevation Left Main coronary artery
II,III,aVF: ST
Segment depression
Anterior wall V2-V4: ST segment Left anterior descending
Elevation (LAD)
II,III,aVF: segment depression
Anteroseptal V1-V4:segment elevation LAD and branches supplying
II,III,aVF: segment blood to septal wall
depression
Anterolateral I,aVL,V3-V6:ST segment LAD and branches supplying
II,III,aVF: ST segment blood to the lateral wall
Depression
Lateral wall V5,V6,I,aVL: Pathologic LCx and or LAD
Q wave, ST segment
Elevation, inverted T wave
Inferior wall II,III,aVF: Pathologic RCA and or LCx
Q wave, ST segment
Elevation, inverted T wave
Posterior wall V1-V3: ST segment RCA and or LCx
Depression, tall upright,
symmetrical R wave, and
tall symmetrical T wave
V7-V9: ST segment elevation (these are leads placed on pt’s left back in the fifth intercostal space.)
Right Ventricle V3R-V6R: ST segment elevation Proximal RCA
( these are right precordial leads)
Ekg changes found in vol67 no5 May 2004 RN
Eyes Open eyes
Opens eyes on request
Opens eyes on pain
Fails to open eyes
Verbal Appropriate conversation
Response oriented to month and year
Confused and or disoriented
Inappropriate conversation
Incomprehensible sounds
No sounds
Motor Follow simple directions
Response Removes pain source
Withdraws from pain source
Non-purposeful flexion (decorticate)
Non-purposeful extension
(decerbrate)
No motor response
Osmolarity
Below 275 Hypotonic
275-295 Isotonic
IV Solutions
Isotonic: L.R., D5W, NS
Hypotonic: 1/2 NS, .33NS, D2.5W
(155)
Hypertonic: D5NS, D5 1/2NS, D5LR, D10W
(406)
Osmolarity
(2xSerum Na)+(glucose/18)+(Bun/2.4)
Anion Gap
Na-(Cl+HCO3)=>15
Normal P-R interval 0.12-0.2
Normal QRS 0.04-0.12
"For ACLS Algorithms: This if from my Critical Care Syllabus (NU 403-Med.Surg. Nsg II)" Contributed
by Dr. Hatfield
Mgmt of MI patient: MONA Be A Friend, Please!
Morphine
Oxygen
Nitrates
ASA (within 24 hrs of admission and on discharge)
BB (within 24 hrs of admission and on discharge)
ACE-I or ARB for LVSD (EF <40%)
Fibrinolytic within 30 minutes of arrival
PCI within 90-120 minutes of arrival
VT/VF Algorithms: AAA SCREAM
AAA: Assess the patient first (not the monitor)
Activate Emergency Response
Action- start CPR
SCREAM
Shock at 200 joules(with biphasic defrillator) or 360 (monophasic)
CPR x 2 min.
Rhythm check: if still in VT?VF give...
EPI or Vasopressin IV or IO ( no more meds down the ET tube)
CPR x 2 min. and shock at 200 joules
Antiarrythmic meds: Amiodarone IV/IO
CPR x 2 min. and shock at 200 joules
Antiarrythmic meds: consider Lidocaine in Amio. not effective
CPR x 2 min. and shock at 200 joules
Antiarrythmic meds: consider Mag Sulfate IV/IO but only if Mg is low or pt in Torsades de Pointes
If pt is acidotic: NaHco3 (draw ABG's)
If pt converts out of VT/VF: hang a drip based on the med bolus used (Amio or Lidocaine)
Asytole Algorithm:
"maybe we should give some CEA"
CPR
Epi or Vasopressin
Atropine
Bradycardia Algorithm:
"Pacing always ends danger"
Pacer transcutaneous
Atropine
Epi
Dopamine
If the patient is resuscitated, considered differential diagnoses (what caused the code to occur); order CXR, lab work, 12 lead EKG and
speak with the family.
FYI: 12 lead EKGs are recommended standard equipment in all mobile pre-hospital transportation vehicles. Guidelines also state
that fibrinolytics can be administered to chest pain victims if arrival time to ED is going to be over 60 minutes from onset of chest pain
(RN, May 2001, pg. 75).
Pulseless Electrical Activity (PEA)
Treat the cause first!
Causes: Remember 5 “H's” and 5 “T's”
Hypoxia* Tension Pneumothorax
Hypovolemia* Tamponade (Cardiac)
Hypothermia Tablets (drug overdose)
Hyper/hypokalemia Thombosis, coronary (ACS)
Hydrogen ion -acidosis Thrombosis, pulmonary (embolism)
*Most common causes
Algorithm “P-E-A”:
Possible causes-always give 500 cc bolus of fluid since hypovolemia is common cause.
Epinephrine 1 mg IV q 3-5 minutes
Atropine 1 mg IV q 3-5 minutes
Consider transcutaneous pacing
Dopamine after rhythm and pulse returns to treat BP
Parkland Burn Formula
(%TBSA burn area x Pt. Wt. In Kg ) divided by 4 = ml /hr
Children and infants require additional fluid beside the calculated fluid resusciation. The maintenance fluid is D5LR
( because of risk of hypoglycemia)
Maintenance formula: 4cc/kg/hr for the first 10kg
plus 2cc/kg/hr for 10-20kg
plus 1cc/kg/hr for over 20kg
IV Fluids infusion factor
( Total amount (ml) x your drop factor ) devided by total time in min. = drops/min
Cockcroft-Gault Equation for Calculating Creatinine Clearance
Creatinine clearance= (140-age) x weight (kg)
serum creatinine (mg/dl) x 72 ( x 0.85 for women)
Note: Special considerations- for patients over the age of 90 years use 90 years old for age
- for obese patients, use the ideal body weight:
Men=50kg + 2.3 kg for every inch over 5 feet
Women+ 45.5kg + 2.3kg for every inch over 5 feet
EKG Changes in MI
Site of
Infaraction Changes seen Possible occlusion
Large anterior V1-V6: ST segment
Wall elevation Left Main coronary artery
II,III,aVF: ST
Segment depression
Anterior wall V2-V4: ST segment Left anterior descending
Elevation (LAD)
II,III,aVF: segment depression
Anteroseptal V1-V4:segment elevation LAD and branches supplying
II,III,aVF: segment blood to septal wall
depression
Anterolateral I,aVL,V3-V6:ST segment LAD and branches supplying
II,III,aVF: ST segment blood to the lateral wall
Depression
Lateral wall V5,V6,I,aVL: Pathologic LCx and or LAD
Q wave, ST segment
Elevation, inverted T wave
Inferior wall II,III,aVF: Pathologic RCA and or LCx
Q wave, ST segment
Elevation, inverted T wave
Posterior wall V1-V3: ST segment RCA and or LCx
Depression, tall upright,
symmetrical R wave, and
tall symmetrical T wave
V7-V9: ST segment elevation (these are leads placed on pt’s left back in the fifth intercostal space.)
Right Ventricle V3R-V6R: ST segment elevation Proximal RCA
( these are right precordial leads)
Ekg changes found in vol67 no5 May 2004 RN
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