Prioritization Beyond ABCs Highest ABC’s Circulation Breathing = RR & Oxygenation PRIORITY Bleeding: Internal: Low PaO2 (Norm: 80 - 100) 60 or less = HypOXemic Respiratory failure High CO2 50 or MORE = HyperCapnic Respiratory failure Hypoxia Airway = blockage Stridor “squeak” - Postoperative Thyroid / Parathyroid Anaphylaxis: throat swelling Epipen 1st! Ruptured esophageal varices Turn to side lying position Hypotension “Low BP” Hard stiff “board-like” abdomen Skin: Pale, dusky, cool & clammy Coagulation: Platelets (norm: 150k - 400k) Less than 150k - Thrombocytopenia Change LOC: Level of consciousness Mental changes: Restless, agitation Skin: Pale, dusky, cool & clammy Less than 50k - VERY RISKY! Heparin: PTT 46 - 70 SpO2% (Norm: 95 - 100%) 1st 3 x MAX range HIGH CO2 HyperCapnic CO₂ WarfarIN 2-3 CO₂ CO₂ CO₂ CO₂ CO₂ 6 7 8 9 13 14 0 1 10 12 2 3 5 11 S HeParin 46 - 70 PTT 4 Shock Warfarin: INR 2 - 3 COPD - Low 90% is normal S T Circulation Severely low blood pressure TROPONIN > 0.5 Shock - Severe low BP 100 10 Urine output 30ml/hr or less 1 0.1 0.01 0 1 2 3 Skin: Pale, dusky, cool & clammy Chest pain (any kind) > 180 Troponin Over 0.5 HIGH LOW NORMAL HTN crisis (over 180 systolic) LOW NORMAL Labs Infection After any surgery! Red, warm, smelly drainage at surgical site WBC over 10,000 Priority: Neutropenia (Less than 1,500 WBC) Chemotherapy, Immunosuppressants Low grade fever will KILL! Pain Low Glucose Lose life or limb Less than 70 “Hypoglycemia” Hypogly = Brain will DIE! Chest Pain = #1 priority Kidney problem Low Grade FEVER <100.4 F = Pain Unrelieved with pain meds Urine output 30 ml/hr or less = Kidneys in distress Side note Kidney Killers CT contrast Antibiotics: Vancomycin & Gentamicin #1 Lithium 1.5 + Digoxin 2.0 + Theophylline 20 + Phenytoin 20 + (brand: Dilantin) Creatinine <1,500 Cast / broken limb pain Creatinine OVER 1.3 = Bad kidney! Toxic lab levels Neutropenia HIGH Infection sys > 1.3 Urine Output < PRIORITY LIMB 30ml/hr Compartment Syndrome BUN/Creatinine Notes