Signs of Pneumonia: High Risk for DIC:

1. Shortness of breath 1. Infection in blood (Sepsis)

2. Rapid, shallow breathing 2. Severe tissue injury, as in
3. Auscultation: Isolated crackles or crackles/ronchi throughout burns, head injury, trauma.
4. SpO2 levels decreasing below patient normal value 3. Recent surgery or anesthesia
5. Cough: either dry or productive (green, brown, yellow, bloody) 4. Reaction to transfusions
6. Chest pain that worsens with deep breath or when coughing 5. Labor & delivery problems
7. Fever, shaking, chills 6. Liver disease
8. Lab Values: Increased WBC and/or increased neutrophils
9. X-Ray High Risk for ARDS:
10. Organisms in sputum 1. Aspiration
11. Pt. may be pale, dusky, blue 2. Pneumonia
12. Diaphoretic, loss of appetite, fatigue and (in elderly) confusion 3. Sepsis
4. Transfusion
5. Lung contusion
Early signs of Sepsis: (#1 killer in of Critical Care patients)
6. Inhalation injury
1. Suspected Infection
7. Near Drowning
2. Two out of four:
8. Chemical inhalation
a. Temp>100.4, <96.8
Signs of ARDS
b. HR>90
1, SOB
c. RR >20 or PCO2<32
2. Labored
d. WBC >12,000 or <4000 or 10% bands
3. Cyanosis
3. SBP <90 after 20-30cc/kg fluid bolus (1.5-3 liters of fluid)
4. Tachypnea
4. Elevated lactic acid ( LDH, Lactate)
5. Decreased BP (Shock)
5. Decreased platelets
6. Organ failure
6. Decreased PO2 below patient normal
7. Rales/ crackles (fluid)
4. Altered mental status not due to drugs may signify organ failure.
8. ABG = Respiratory Acidosis
Signs of Severe Sepsis:
9. Chest X-Ray
1. Patient receiving antibiotics & needs Vasopressor (this is a
dangerous sign).
2. Pt showing signs of organ failure in 2 + systems for <= 24 hrs. High Risk for PE:
3. ARDS, DIC, MSOF 1. Prolonged bed rest, long car
Criteria for Organ Failure: car or plane rides, etc.
1. Cardiovascular: 2. Surgery, especially pelvic
a. SBP <= 90 3. Child birth
b. MAP <= 70 for 1 hour or CVP >8-12 4. Massive trauma
c. CK, CKMB, Troponin elevated 5. Cancer
2. Hemodynamics: 6. Stroke
a. Platelets <80,000 7. Heart attack
b. 50% decrease in platelets over 3 days 8. Heart surgery
3. Renal: 9. Fracture of hip or femur
a. UOP < 20cc/hour (with CVP >8-12) Signs of PE:
b. High Creatinin and BUN , GFR >29 1. Tachypnea: increased rate
c. Increased electrolytes (High K, Mg, and Na) and depth. (70% of cases)
d. Increased Uric Acid 2. Rales (50% of cases)
e. Metabolic Acidosis 3. ABG is normal
f. Increased BP 4. Dyspnea at rest
g. Prolonged bleeding 5. Diaphoretic
4. Hepatic: 6. Chest pain occurs suddenly &
a. Jaundice may worsen with deep breath,
b. High AST and ALT, Biliruben, Gamma-Gt cough, movement
c. Decreased Albumin 7. Cough began suddenly,
d. Coagulation abnormalities may be bloody sputum
5. Metabolic: 8. Tachycardia (30% of cases)
a. <=7.30 9. Anxiety
b. BE >= 5 10. Bluish or dusky skin
c. Lactate >2.0 once CVP> 8-12 11. D-Dimer (70% false positive).
6. Respiratory: 12. V/Q Scan (best indicator 87%)
a. PaO2/FiO2 <= 250 13. Treatment – preventative
b. Early ABG = Respiratory Alkalosis due to high RR (support ventilation,
a. Later ABG = Metabolic Alkalosis due to low perfusion anticoagulants)