Aa gradient PAO2 PaO2

1
Pancreatitis Glasgow score Age gt 55 pO2 lt 8
kPa WCC gt15 x 109/L Ca2 lt 2.0mmol/L LDH gt600
IU ALT gt100 IU Glu gt10mmol/L U gt16mmol/L Alb lt
32g/L
A-a gradient PAO2 - PaO2 (where PAO2 FiO2 x
(pATM-pH20) - (PaCO2/RQ) FiO2 0.20-1.0, ATM
760, pH20 47, RQ0.8
Haematology Hb ? 13-18 g/dL ? 11.5-16
g/dL Haematocrit ? 0.4-0.5 ? 0.36-0.46 MCV 76-96
fL MCH 27.0-32.0 pg MCHC 31.0-35.9 Fe ? 14-32
µmol/L ? 10-28 µ mol/L B12 120-680 pmol/L Folate
7-45 nmol/L Ferritin ? 30-300 µg/L ? 15-200
µg/L Transferrin 204-360 mg/dL TIBC 262-474
µg/dL Reticulocytes 0.5-1.5 RBCs Platelets
150-400 x 109/L WCC 4-11 x109/L Neu 40-75
(2.0-7.5 x109/L) Lym 20-45 (1.5-4.0
x109/L) Mon 4-10 (0.2-0.8 x109/L) Eos
1-6 (0.04-0.4 x109/L) Bas 0-2 (lt0.1
x109/L) APTT 25-35 secs PT 13-17 secs Bleeding
time lt9 mins INR 0.9-1.2 (anticoag Rx e.g.
2.0-3.0) Blood gases pH 7.35-7.45 PaO2 gt10.6
kPa (75-100 mmHg) PaCO2 4.7-6.0 kPa (35-45
mmHg) HCO3- 22-29 mmol/L Base excess 2
mmol/L LFTs Bilirubin 3-17 µg/L ALT 3-35
iu/L AST 3-35 iu/L ALP 30-150 iu/L ?GT 8-78
iu/L UEs Na 135-145 mmol/L K 3.5-5.0
mmol/L Cl- 98-106 mmol/L Ca2 2.12-2.65mmol/L
Urea 2.5-6.7mmol/L Cr 70-150 µmol/L Albumin
35-50 g/L Proteins 60-80g/L TFTs T4 70-140
mmol/L TSH 0.5-5 µiu/L Lipids and others Chol
lt5.5 mmol/L LDL lt2.6 mmol/L HDL 1.0-2.2
mmol/L TAGs 0.5-1.9 mmol/L BM (fasting) 3.5-5.5
mmol/L BM (random) 3.5-11.1 mmol/L Amylase 0-180
iu/dL CRP lt10 mg/L Temp 36.5-37.2
oC Cardiac Troponin lt0.2 ng/ml CK 25-195
iu/L LDH 70-250 iu/L Urine U Na 75-300
mmol/L U K 40-100 mmol/L U 24hr protein lt0.15
g U osmol 500-800 mOsm/Kg Serum osmo 280-296
mOsm CSF CSF glucose serum ratio gt0.6 Protein
15-45 mg/dL Cells RBCs 0 /µL WBCs 0-3 /µL
GCS M6 V5 E4 M1 no response to pain V1 none E1
none M2 extensor to pain V2 incomprehensible E2
to pain M3 flexor to pain V3 inappropriate E3 to
speech M4 withdraw to pain V4 confused E4
spontaneous M5 localise to pain V5 oriented M6
obeys command
MRC power grade 0 none1 flicker 2 w/ gravity
eliminated 3 vs. gravity 4 vs. resistance 5
norm
Rockall score (initial /7, after OGD /11) Age 0
lt60 years 1 60-79 yrs 2 gt80 yrs Shock 0 None1
pulsegt100 sys BPgt1002 sys BP lt100 Co-morb 0
none 2 cardiac failure, IHD or any major
co-morbidity 3 renal/liver failure, or dissem
malig Endosc Dx 0 MW tear, no lesion, no SRH
1 all other Dx 2 malig UGI tract SRH 0
none/dark spot 2 blood in UGI tract/adherent
clot/visible or spurting vessel
Mod ABCD score TIA/stroke (/6) Age 60 BP
140/90 Clinical features (speech 1, unilat
weakness 2) Duration (10-59min 1 60min 2) DM
TIMI score (1 point each /7 front door /6) Age
65 3 CAD risks (FHx, HTN, ? chol, DM, active
smoke) known CAD (stenosis 50) ASA past 7/7
recent ( 24hr) severe angina ? trop ST dev
0.5mm
Wells score DVT (1 point each 0 low, 1-2 mod,
3 high) Active ca Paralysis/paresis/POP
immob Bedriddengt3/7 or maj surg lt12/52 Tenderness
along deep veins Entire leg swelling Calf
swelling gt3cm in Sx leg Pitting oedema in Sx
leg Colllateral superficials
Wells score PE ( 4 low, 4.5-6 mod, gt6 high) 3
Signs Sx of DVT 3 PE most likely Dx 1.5
Surgery/bedridden gt3/7 during last 4/52 1.5
Prev DVT/PE 1.5 HR gt 100min 1 Haemoptysis 1 Acti
ve ca
ORH anticoagulation induction Day 12 5 mg each
eve if baseline INR lt 1.4 Day 3 lt1.5 10 mg
1.5-2.0 5 mg 2.1-2.5 3 mg 2.6-3.0 1
mg gt3.0 0 mg seek advice Day 4 lt1.6 10
mg 1.6-1.7   7 mg 1.8-1.9      6
mg 2.0-2.3      5 mg 2.4-2.7      4
mg 2.8-3.0     3 mg 3.1-3.5     2
mg 3.6-4.0     1 mg gt4.0         0 mg seek
advice
Reversible causes of arrest Hypoxia,
Hypovolaemia, Hyper/hypokalaemia/metabolic
disorders, Hypothermia Tension pneumothorax,
Tamponade, Toxins, Thromboembolism
Red flags Headache subarach, subdural, temp
arteritis, meningitis? Fall old person secondary
subdural? Confusion old person UTI or
subdural? Back/flank pain AAA? Back pain cauda
equina? (incontinence, weakness, PR) Chest pain
( breathlessnes) PE? Scrotal swelling
torsion? COPD beware giving NSAIDs/aspirin Head
injury beware morphine (neuro obs) PPIs/H2
blockers masking Sx gastric ca?
Drugs Adrenaline (anaphylaxis) 0.5mg of 1 in 1000
IM Chlorphenamine 10-20mg IM/IV (max 40mg/24hr)
or 4mg/6hr PO Codeine phosphate 30-60mg 4hr PO/IM
max 240mg/24hr Cyclizine 50mg 8hr
PO/IM/SC Flumazenil 200µg IV over 15s, then 100
µg each 60s if req, max 1mg Haloperidol 0.5-5mg
4-8hr IM/IV max 18mg Lansoprazole 15-30mg/24hr
PO Loratadine 10mg/24hr PO Metoclopramide 10mg
8hr PO/IM/IV Morphine 2.5-5mg 2-4hr
PO/IM/SC Naloxone 400microg IV 2-3mins repeat to
max 10mg Omeprazole 20-40mg/24hr PO Ondansetron
8mg 8hr PO or 4mg IM/IV Paracetamol 0.5-1gram 4hr
PO max 4g/2hr Ranitidine 150mg/12hr PO Temazepam
10-20mg nocte Tramadol 50-100mg 4hr
PO/IM/IV Zopiclone 3.75-7.5mg nocte
Ed Mitchell