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.
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
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