Page 192 - Critical Care Notes

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GI
■ Nausea and vomiting
■ Fever, diaphoresis, and weakness
■ Tachypnea, ↓ BP, ↑ HR, and other symptoms of hypovolemic shock or
respiratory distress
■ Hypoactive or absent bowel sounds, and abdominal tenderness and
distention
■ Ascites and jaundice if illness severe
■ Steatorrhea: Fatty, foul-smelling stools
■ Pancreatic hemorrhage → Grey Turner’s sign (gray-blue
discoloration of the flank) or Cullen’s sign (discoloration of the umbilical
region)
■ Palpable abdominal mass if pseudocyst or abscess present
■ Hypocalcemia causing twitching and seizures; hyperlipidemia
■ Restlessness, mental confusion, agitation
Ranson’s Criteria for Predicting Mortality
in Pancreatitis

Assessment completed on admission and again in 48 hr.
On Admission 48 Hours After Admission
Age >55 y.o. 1 point Hct decrease >10% 1 point
WBC >16,000 cells/mm 2 1 point BUN >5 mg/dL after IV 1 point
Serum glucose >200 mg/dL 1 point hydration
Serum LDH >350 IUnits/L 1 point Serum calcium <8 mg/dL 1 point
Serum AST (SGOT) 1 point Arterial PO 2 <60 mm Hg 1 point
>250 Units/mL Base deficit >4 mEq/L 1 point
Fluid sequestration/ 1 point
needs >6 L
■ Score of <3 predicted mortality 1%
■ Score of 3–4 predicted mortality 15%
■ Score of 5–6 predicted mortality 40%
■ Score of >6 predicted mortality 100%
Diagnostic Tests
■ Serum amylase (30–220 Units/L [SI units] normal) and/or lipase (0–160 Units/L
[SI units] normal) more than three times the upper limit of normal
■ Serum lactate

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