HISTORY
& PHYSICAL
|
CC:
|
Patient’s complaint in his/her own
words.
|
|
History (Hx) of
Present
Illness:
|
Chronological account of problem, onset,
setting, timing, frequency, location, quality, quantity & severity,
aggravating & alleviating factors, associated manifestations, treatments,
relevant laboratory values (if transferred from outside hospital),
significant negatives & other relevant information.
|
|
Past Medical
Hx:
|
General: Previous diagnoses & date of diagnosis, complications of prior
illnesses, outcome, hospitalizations.
Childhood Illness:
Polio, measles, mumps, rubella, whooping cough, chicken pox, rheumatic fever,
scarlet fever.
Adult Illness: Complete list of medical,
OBGyn, Psychiatric to include accidents & injuries.
Screening tests: HCT, PPD, PAP
smear, hemoccult, urinalysis, fasting blood glucose, cholesterol, echo,
mammogram, PSA.
Immunizations:
Tetanus, pertussis, varicalla, diphtheria, polio, measles, rubella, mumps,
Influenza, pneumococcal, Hep B.
|
|
Past Surgical
Hx:
|
Operations listed by date, reason,
outcome, complications.
|
|
Family Hx:
|
Age of parents &
immediate family members. General health, age at death. Diabetes, heart
disease, hypertension, blood transfusions, stroke, cancer, kidney disease,
bleeding disorders, asthma, arthritis, tuberculosis, epilepsy, mental
illness, other symptoms of presenting illness.
|
|
Social Hx:
|
Current residence, education, employment, persons at
home, diet, exercise; tobacco, alcohol, or drug use – amount, frequency,
duration of each. If patient quit—how
long.
|
|
Medications:
|
Name of drug, dose,
frequency, duration, compliance, reasons for taking meds, availability, side
effects/complications. Must include home remedies, vitamins, OTC medications,
minerals & herbal supplements.
|
|
Allergies:
|
Food or medication reaction, response to agent (rash,
swelling, etc.).
|
|
Review of
Systems:
|
1.
General:
Recent weight change, fatigue, weakness, fever, night sweats. Are clothes
fitting the same.
2.
Skin: Rashes, lumps, sores, hair & nail
changes, dryness, itching, moles.
3.
HEENT: trauma, headache location/frequency,
dizziness, nausea, vomiting, visual changes, diplopia, tearing, hearing loss,
tinnitus, vertigo, earache, rhinorrhea, stuffiness, sneezing, allergy,
epistaxis, bleeding gums, hoarseness, sore throat, swollen neck, goiter.
4.
Breasts: Lumps, tenderness, skin changes,
rashes, masses, pain, nipple discharge, dimpling, self exams practices.
5.
Lungs: Wheezing, cough, difficulty breathing,
pain, sputum color, hemoptysis, asthma, pleurisy, bronchitis, emphysema.
6.
Heart: Palpitations, HTN,
rheumatic fever, tightness, murmurs, pillow orthopnea angina, dyspnea, edema,
hypertension, EKG.
7.
GI:
# of BM/day, constipation, N/V/D, heart burn, appetite, melena,
hematemesis, abdominal pain, color & size of stool, regurgitation,
indigestion, dysphagia, hematechezia, belching/gassiness, hemorrhoids.
8.
Urinary: Burning or pain upon urination,
frequency, hesitancy, urgency, dribbling, polyuria, nocturia, hematuria,
dysuria, incontinence, stones, infection.
9.
Genital: General: STDs history/treatment, HIV
status, contraception, sex interest & function.
Male: Hernias, penile discharge, sores, testicular pain
or masses, hernias, self examination.
Female: Menarche, period regularity, frequency, duration,
Age of menarche, period (regularity, frequency, & duration),
dysmenorrhea, last period, itching, discharge, sores, pregnancies and/or
complications, miscarriages, delivery, abortions, birth control,
menopause/post menopausal bleeding, hot flashes/sweats, dyspareunia.
10.
Vascular:
Intermittent claudication, edema, varicose veins, thromboembolic
disorders.
11.
Musculoskeletal: Muscle weakness, range of motion,
arthritis, instability, pain, joint stiffness, swelling, backache, gout.
12.
Neurologic: Blackouts, fainting, seizures, loss of
sensation, tingling, tremors, weakness, paralysis, numbness.
13.
Hematologic: Petechiae, purpura, anemia, easy bruising, bleeding,
transfusions & reactions.
14.
Endocrine: Thyroid disorders, heat & cold
intolerance, excessive sweating, polyuria, polydipsia, polyphagia.
15. Psychiatric: Anger, hostility, emotion, anxiety, depression, confusion,
nervousness, belligerent.
|
|
Physical Exam:
|
1.
General: Weight changes, fatigue, weakness,
fever, chills, night sweat, state of health, development.
2.
Vitals: Temperature, BP, HR, RR, SaO2,
height, weight.
3.
Skin: Lesions, scars, piercing, rashes,
bruises, hair texture.
4.
Head: Size/shape
of head, lacerations, & lesions.
5.
Eyes: Pupil size (equal, reactive, symmetric), extra
ocular muscle, deviations, scleral icterus, conjunctiva, papilledema,
hemorrhage infection, tearing, cataracts visual acuity, nystagmus.
6.
Ears: Infection, discharge, hearing aids, tympanic
membranes, auditory acuity, impaction.
7.
Nose/Sinuses: Pharyngeal exudates, septal deviation, dishcharge,
mucosa color, epstaxis, rhinitis, patency, nasal polyps, sinus inflammation
or congestion.
8. Mouth/Throat: Buccal mucosa, tonsilar enlargement gingivitis,
dentures, ulcers, halitosis, lacerations, dental health.
9.
Neck: Swollen neck, goiter, adenopathy, or masses, range of motion, tracheal
deviation, nodules, thyromegaly.
10.
Breasts:
Size/symmetry, shape, contour, skin changes, consistency, tenderness, masses,
rashes, dimpling, discharge.
11.
Lungs: Strider, intercostals tenderness, chest
symmetry w/ respirations, tympany, resonance, wheezes, crackles, fremitus,
percussion, egophony, cough.
12.
Heart:
Rate, rhythm, murmurs, heart sounds (s4, s1, s2, s3), rubs, gallops, JVD,
HJR, clicks, palpitation, PMI.
13.
Abdomen:
Bowel sounds, consistency (soft vs. firm), tenderness, rebound, masses,
hernias, bruits, guarding, spleen size, liver span, percussion (tympany,
shifting dullness), CVA tenderness appetite changes, venous hum.
14.
GU:
Male – rashes, cysts, chancre,
ulcers, warts, meatus, nodules,
inflammation, inguinal adenopathy,
discharge, scrotal edema,
masses, hair pattern, hernias; Female
– warts, chancre, external genitalia, papules, clitoris, vaginal mucosa,
inguinal adenopathy, cervical changes, hernias, discharge, bleeding, ulcers, nodules,
adnexal masses/ovaries, uterus.
15.
Rectal: Male
- sphincter tone, rectal mass, sphincter tone/laxity, nodules, seminal
vesicle, prostate consistency & size, hemorrhoids. Female - rectal shelf, rectal polyps, masses, fissure/fistulas,
hemorrhoids.
16.
Vascular:
Pulses (radial, popliteal, dorsalis pedis, posterior tibial), superficial
inginual nodes, edema, varicose veins, palor, rubor, claudication, radial,
femoral, popiliteal, posterior tibial, carotid bruits, edema, ulcers, skin
thickening.
17.
Musculoskeletal:
Arthritis (swelling, warmth, tenderness, redness), joint stiffness, bursitis,
atrophy, range of motion, posture, instability, muscle strength, scoliosis,
phase of gait, carpal tunnel (Phalen’s test & Tinel’s sign).
18.
Neurologic: Tingling, paralysis, fainting. See “Neurology” for full neurologic exam.
|
|
Labs:
|
Fluid balance, hematology, urinalysis,
coagulation panel, cultures, EKG, any imaging results, etc.
|
|
Assessment/Plan:
|
Differential Diagnosis – state each possibility & reasons for inclusion or
exclusion from history, physical, & lab results; medications to be
started, procedures & additional labs to be done, consults to be
obtained, etc.
|
Neurological Exam
Cranial nerve exam
I Olfactory (S)
|
Sensory input for smell
|
|
II Optic (S)
|
Sensory input for vision
|
|
III Oculomotor
(M)
IV Troclear (M)
|
Raises
eyelids, focuses lenses, & adjust light entering eyes
Moves Superior Oblique
|
|
V Trigeminal (B)
Vl Ophthalm
V2 Maxillary/
V3Mandibular
VI Abducent (M)
|
Sensory for cornea, scalp, forehead, eyelids
Sensory
to face, teeth, gum, lips jaw opening, bite strength
Lateral
rectus movement
|
|
VII Facial (B)
|
Facial expression, raise eyebrow, close eyelid, taste (ant 2/3
of tongue).
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|
VIII Vestibulocochlear
(S)
|
Sensory for hearing & equilibrium/Rinne/Weber tests/
Oculocephalic reflex.
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|
IX Glossopharyngeal (B)
|
Sensory to posterior tongue, pharynx, tonsils, swallowing &
some BP.
|
|
X Vagus (B)
|
Muscle of speech & swallowing. Impulses to heart & smooth muscle of
the viscera.
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|
XI Spinal Accessory (M)
|
Shrugs shoulder & turns head.
|
|
XII
Hypoglossal (M)
|
Moves tongue
|
(B)oth=(S)ensory & (M)otor function
:: Some Say Marry Money But My Brother Says Big Brain Matters Most.
SENSORY
VIBRATIONS Use
a tuning fork (128Hz), place fork over the distal interphalangeal of index
fingers & big toes.
POSITION SENSE Grasp patient's big toe & move it
"up" & "down."
toe. Have the patient identify the direction you move the toe.
DERMATOMAL Shoulders (C4), Inner & outer aspects of the
TESTING
forearms (C6 & T1), Thumbs & little
fingers (C6 & C8), Front of both thighs (L2), Medial & lateral aspect
of both calves (L4 & L5), Little toes (S1).
PAIN Use object to test "sharp" or
"dull"
sensation.
DESCRIMINATION Graphesthesia, Stereognosis, Two Point
Discrimination.
STRENGTH
GRADE
|
MOTOR STRENGTH
|
|
5/5
|
Normal strength against gravity
|
|
4/5
|
Movement against gravity, but less than normal
|
|
3/5
|
Movement against gravity, w/ no other resistance
|
|
2/5
|
Movement at the joint, gravity eliminated
|
|
1/5
|
Visible muscle contraction, w/out joint movement
|
|
0/5
|
No movement
|
REFLEX
GRADE
|
TENDON REFLEX GRADING
|
|
4+
|
Hyperactive w/ clonus
|
|
3+
|
Hyperactive w/ unclonus
|
|
2+
|
Normal
|
|
1+
|
Hypoactive
|
|
0
|
Absent
|
|
Testing:
Nerve/Muscle
|
C7/Radial
N=Triceps
C6/Radial
N=Brachioradialis
C5/Musculocutanous
N=Biceps
L4/Femoral
N=Patellar
S1/Tibial=Achilles
|
CEREBELLUM
|
Rapid Alternating Movements, Point-to-Point
Movements, Romberg.
|
|
GAIT
|
Ask patient to: Walk
heel-to-toe, walk on their toes, walk on their heels, rise from a sitting
position.
|
Mini Mental Status Exam
Maximum
Score
What
time is it? One point for each correct
Year
Season
Date
Day
Month
Where
are we? One point for each correct
State
County
Town
Hospital
Floor
Test giver names 3 objects. Repeat until patient knows them.
Table
Pen
Chair
Serial 7's
Give 3 points
Start w/ 100ŕ93, 86, 79, 72, 65…
Ask the patient to spell WORLD forward then backwards. Give
3 points
Ask the patient to name the 3 objects from above. One point for each correct
Point to your watch & your pen. Have
patient name them. One point for each correct
Repeat the following; "No ifs, ands, or buts." Give 2 points
Ask the
patient to "Take the paper in your right hand, fold it in half, & hold
it between their thumb & middle finger.
Give 3 points
Have them read & perform the following: FROWN. Give 2 points
Copy the
shape of a triangle. Give 2 points
Scoring & Scale
APGAR Scoring
APPEARANCE 2=Pink 1=Blue extremities 0=Blue
ACTIVITY 2=Active 1=Some flexion 0=Limp
HEART 2=>100 bpm 1=<100
bpm 0=Absent
RESPIRATION 2=Strong cry 1=Irregular 0=Absent
IRRITABLE 2=Cough/sneeze 1=Grimace/cry 0=No response
GLASCOW COMA SCALE
Eye Opening Verbal
Activity Motor
response
4= Spontaneously 5= Oriented, appropriate 6= Obeys commands
3= To verbal stimuli 4=
Confused 5= Localizes
pain
2= To pain only 3= Inappropriate words 4= Withdraw to pain
1=None 2=
Incomprehensible sounds 3= Flex in
response to pain
1= None 2= Extend in response to pain
1=
None
ADMISSION
/ TRANSFER ORDERS/Remember “ADC2 Va2ndimls”
ADMIT
|
Floor, Service, Attending, Resident,
Intern, Telemetry
|
|
DIAGNOSIS
|
List most likely possibility first
|
|
CONDITION
|
good / stable / fair / guarded / critical, etc.
|
|
VITALS
|
q shift / per routine/ q 4 hrs / q 2 hrs, etc.
|
|
ACTIVITY
|
ad lib / bed rest / up to chair, OOB to chair, etc.
|
|
ALLERGIES
|
List: if none then NKDA = “no known drug allergies”
|
|
NURSING
|
Make a list of tasks for
the nursing staff, i.e. IVF, BP, RR, PR, temp, SCDs “ins & outs q shift”, “bed to
telemetry”, “elevate head of bed”, “change dressing bid”, “foley to gravity”,
etc.
|
|
DIET
|
NPO / regular / clear liquids / ADA / cardiac, etc.
|
|
IV FLUIDS
|
D%NSS/ at what rate
& # of bags, always ensure IV access.
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MEDS
|
List medical management, consider
patient comfort & & sleeping conditions.
|
|
LABS
|
CBC w/ chem 7, Ca+, Mg+, Phos+, ABG, EKG, urinalysis, CXR,
etc.
|
|
SPECIAL
|
PT/OT, diabetes counselor, social services, home health, other
consult services, etc.
|
|
CALL IF
|
SBP > 160 OR <90, DBP > 110 OR
< 50, Temp > 101 or < 97, HR > 110 or < 60, RR > 24, etc.
|
GUIDELINES FOR ISOLATION
Standard
Precautions/Universal Precautions
Use Standard Precautions
(gloves) for ALL patients when
handling: body fluids, secretions & excretions except for sweat as well as
non-intact skin & mucous membranes. Gloves must be changed between
patients, between tasks, or when torn.
1. Airborne Precautions
(particles 5 microns or smaller in size) requires additional barriers to be
worn (gowns, splash shields, goggles, masks).
Illnesses such as: TB, Varicella (chickenpox), including disseminated
Zoster; patients must be placed in a room w/ negative air pressure. Hospital personnel & visitors must wear
the TB respirator.
2. Droplet
Precautions (greater than 5 microns in size) is indicated before contact w/
mucous membranes or fluids of the conjunctivae, nose or mouth of a susceptible
person. These include: Influenza,
Diphtheria, Invasive H. influenzae, Pertussis, Invasive N. Meningitidis. Droplets are often generated (usually within
3 feet) during sneezing, coughing, talking, & during certain procedures
such as suctioning or bronchoscopy.
3. Contact
Precautions reserved for patients/objects w/ Multi-Drug Resistant Bacteria
(MRSA, VRE), enteric infections
from C. difficile, highly contagious skin infections = scabies, major
abscesses, impetigo, Herpes Simplex, Zoster, etc.
4. Neutropenic
Precautions are for patients who need protection from pathological
microorganisms found in fresh flowers, plants & vegetables; these should
not be allowed in patient’s room.
Cautions when ordering meals= avoids uncooked foods (including fresh
fruit, vegetables or black pepper). Must
avoid enemas, digital rectal exam, rectal tubes or NG tubes to prevent
translocation of bacteria from gut. Neutropenic
Precautions= Once patients become neutropenic, neutropenic isolation is
enforced until counts recover. Patient should not leave room until count
recovers; they remain afebrile & off antibiotics & show no evidence of
infection. Fever >100.5 should
be regarded as an emergency, w/ immediate evaluation of patient & vitals.
Cultures should be drawn & appropriate antibiotics administered within 1
hour for stable-appearing patients, more urgently if unstable.
Calculating ANC (Absolute Neutrophil Count = absolute segs + bands) to make sure
patient is not neutropenic = ANC <1000 when falling or <500 when rising
(usually happens day 7-11 after day 1 of chemo).
Diets
Regular=Regular
diet, comes w/ salt, pepper & sugar packs.
Cardiac=Cooked
w/ low salt, fat, cholesterol; usually only salt substitute; ideal for patients
on cardiac service or w/ cardiac/weight problems.
NAS=No Added
Salt (means “no added salt” to tray) =No salt packet given, however food
is cooked w/ NORMAL
amounts of salt; for patients who don’t have to be on a strict diet.
Low Protein=For
patients w/ liver problems, hepatic encephalopathy, or other problems w/
metabolizing protein.
Renal Standard=Incorporates
a low protein diet; renal pts w/ ARF to CKD.
Diabetic Standard=Low sugar, carbs, sugar free desserts.
Lower calorie
diabetic diet= (ADA 1800 calorie, ADA 1600 calorie).
Neutropenic=Means
no fresh fruit, vegetables or black pepper.
Most facilities can provide a “mechanical soft” or
“pureed” diet.
ADMISSION/DISCHARGE NOTE
|
DATE
|
|
|
ADMISISON/DISCHARGE DIAGNOSIS
|
List them in the order of importance.
|
|
SERVICE
|
Service, Attending, Resident, Intern
|
|
CONSULTS
|
Service, Attending physician, Date
|
|
PROCEDURES
|
Procedure name, Date, Results (this includes ABG, CT, MRI,
Echo, US & pathology report, etc.).
|
|
HISTORY & PHYSICAL
|
Just the applicable information from the H&P
|
|
COURSE
|
State complications in order of severity
w/ & a brief summary of hospital course & treatment, including
problems/resolution at discharge.
|
|
CONDITION
|
Good / stable / fair / guarded, etc.
|
|
DISPOSITION
|
Discharged to home, nursing home, etc.
|
|
MEDICATIONS
|
Discharge
medications w/ dosage, etc.
|
|
INSTRUCTIONS
|
Activity, diet, care instructions if
problem re-occur.
|
|
FOLLOW-UP
|
Follow-up appointments w/ doctor on date
|
Hospital Notes
Delivery Note:
Patient progressed to full & now
pushing. (Age) female under (epidural,
pudendal, local, no) anesthesia delivered a viable (male, female) infant w/
APGAR scores of (0-10) & (0-10) at 1 & 5 minutes & weighing
(weight). Delivery was via (SVD, LTCT) to a sterile field. Infant was suctioned
at (perineum, delivery). Anterior & posterior shoulders delivered w/out
difficulty. Cord clamped at two places
& cut. Spontaneous expulsion (or manual extraction) of an intact placenta
w/ a (2-3) vessel cords was delivered at (time). Perinium, vagina, vault,
cervix, uterus & rectum explored (w/wo) laceration repairs. Hemostasis achieved w/ EBL (amount). Mother
& infant tolerated procedure well.
Infant taken to NBN in stable condition. Dr. (name) present (attending).
Postpartum Note
|
SUBJECTIVE
|
Pay special attention to: Level of
fundus, quality of uterus (firm, contracted), lochia (quality &
quantity), Episiotomy (intact/ edematous), extremity (edema/tenderness),
contraception, feeding (breast/bottle). Patient w/ +/- complaints, +/-
tolerating PO, +/- void without difficulty,
+/- ambulating, +/- any symptoms of medical illness pertinent to patient'
medical/obstetric history.
|
|
OBJECTIVE
|
Vitals: BP,
HR, Temp (Tmax Tcurrent over
the last 24 hrs)
I's
& O's: (post op
IVF, urine, stool).
Lungs: (prior hx of dz, or on MgSO4).
Abdomen: +/- bowel sounds, +/- tympanny,
Uterus Firm,
Boggy, location, lochia (increasing/ decreasing).
Extremities: Always check for DVT/calf tenderness,
edema (if pre-eclampsia suspected), DTR's (if on MgSO4 or pre-eclampsia
suspected).
Labs: CBC,
PP/ POP, Hct, Blood type (Does
the mother need Rhogam?), Rubella status.
|
|
ASSESSMENT
|
Overall assessment, diet, Problem / Plan
|
|
PLAN
|
Address all problems, immunization,
planned contraception, consult services, d/c plan, postpartum follow-ups, OP
pain management.
|
PRE-OP NOTE
|
PRE-OPERATIVE DIAGNOSIS
|
The reason for the surgery.
|
|
PLANNED PROCEDURE
|
Type of surgery to be performed.
|
|
LABS/RAD
|
CBC w/ chem 7, Ca+, Mg+, Phos+, EKG, CXR, etc.
|
|
BLOOD AVAILABLE
|
T&S,
T&C 4U, platelets, FFP.
|
|
PRE-OP ORDERS
|
NPO, bowel
prep, IVF.
|
|
ANTIBIOTICS
|
Drug, Dose,
Route, Timing (on call, etc).
|
|
CONSENT
|
Completed & on chart.
|
OPERATIVE
NOTE
|
DATE OF SURGERY
|
|
|
PRE-OPERATIVE DIAGNOSIS
|
Type of surgery performed.
|
|
POST-OPERATIVE DIAGNOSIS
|
|
|
ATTENDING
|
Surgeon.
|
|
ASSISTANTS
|
Attending, Resident, Intern, Med
Student.
|
|
ANESTHESIA
|
General:
Endotracheal vs. LMA,
Epidural, Spinal, Regional, or Local.
|
|
FINDINGS
|
To include specimen sent to pathology.
|
|
COMPLICATION
|
None or
Description.
|
|
I/O
|
Crystalloid,
Colloid, Blood.
EBL, Urine, Drains, other.
|
|
SPONGES/INSTRUMENT
COUNT
|
|
|
DISPOSITION
|
PACU, SICU, Floor, Outpatient Recovery.
|
|
CONDITION TO
TRANSFER
|
Stable, guarded, critical, transferred
to (location).
|
PROCEDURE NOTE
|
PROCEDURE
|
|
|
PERMIT
|
Explain the procedure to the patient to include, benefits, risks
(bleeding, infection, trauma, scarring, anesthesia). Be sure options/ alternatives are explained
to patient. Patient must verbally agree & sign consent in order to
proceed.
|
|
INDICATION
|
Meningitis, venous access, ascites,
etc.
|
|
PHYSICIAN(S)
|
Attending, Resident, Intern, Med
student.
|
|
ANESTHESIA
|
General, local, etc.
|
|
DESCRIPTION
|
Area prepped & draped in a sterile
fashion. Describe technique including
body location, instruments, duration of procedure, etc.
|
|
FINDINGS
|
Main surgical findings.
|
|
EBL
|
Estimated blood loss in cc.
|
|
COMPLICATIONS
|
List them if there were any.
|
|
CONSENT
|
Signed/in chart.
|
|
DISPOSITION
|
Patient resting comfortably, breathing
non-labored, incision clean, dry, & intact, etc. Patient ordered to
remain supine for (how many) hrs.
|
POST-OP NOTE
|
PROCEDURE
|
Type of surgery performed.
|
|
SUBJECTIVE
|
Pay special attention to: Patient w/ +/- complaints, +/- any symptoms
of medical illness, n/v, headaches, and document alertness.
|
|
OBJECTIVE
|
Vitals: BP, HR, Temp (Tmax, Tcurrent
over the last 24 hrs).
I's
& O's: (post op
IVF, urine, stool).
Lungs: w/r/r, sob, etc.
Abdomen: +/- bowel sounds, +/- tympanny.
Extremities: Always check for DVT/calf tenderness,
edema.
Labs: CBC,
CHEM-7, etc.
|
|
ASSESSMENT
|
Overall assessment, diet, problem
resolution.
|
|
PLAN
|
Address all problems; consult services,
d/c plan, medications, OP pain management.
|
PROGRESS (“SOAP”)
NOTES
|
Subjective
|
Patient’s status overnight, nurse report, complaints, pain
status.
|
|
Objective
|
Vitals – Temp, Tmax, Tcurrent,
BP range, HR, RR, O2 sat, ventilator settings.
Ins/Outs – IVF/PO fluids,
urine/NG suction/drain volume, #BM/emesis; Physical exam; Meds, Labs/reports,
imaging, etc.
|
|
Assessment/
Plan
|
Describe patient in one sentence. List all problems & how to
manage them, consult services, d/c plan, pain management.
|
Immunization Schedule
Hep B1 Birth (only if mother is HBsAg(-))
Hep
B2 1
to 4 months
Hep
B3 6
to 18 months
DTaP1
2 months
DTaP2 4 months
DTaP3 6
months
DTaP4 15
to 18 months
DTaP5 4 to 6 years
Tetanus
Booster 11 to 12 years
Hib1 2 months
Hib2 4
months
Hib3 6
months
Hib4 12
to 15 months
IPV1 2
months
IPV2 4
months
IPV3 6
to 18 months
IPV4 4
to 6 years
MMR1 12
to 15 months
MMR2 4 to 6 years
VZV 12
to 18 months
PCV1 2
months
PCV2 4
months
PCV3 6
months
PCV4 12-15
months
Hep A1:
2 years or older…selected population.
Hep A2:
6-12 months after Hep A1…selected population.
Influenza: All adults & children over 6 months of
age wishing to avoid getting sick w/ influenza are encouraged to get a flu shot
annually. Children under 9 receiving influenza immunization for the first time
require 2 doses, 4 weeks apart.
Meningococcal:
2 years or older in high risk groups including
college students living in dormitories & U.S Military recruits, people
traveling to or living in high risk areas, such as West Africa, or anyone w/
damaged spleen.
Anticoagulation Therapy
|
Indication
|
INR
|
|
Prophylaxis
of venous thrombosis
|
2.0-3.0
|
|
Treatment
of venous thrombosis
|
2.0-3.0
|
|
Treatment
of pulmonary embolism
|
2.0-3.0
|
|
Prevention
of systemic embolism
|
|
|
Tissue
heart valves
|
2.0-3.0
|
|
Atrial
fibrillation
|
2.0-3.0
|
|
Recurrent
systemic embolism
|
2.0-3.0
|
|
Post-myocardial
infarction
|
2.5-3.5
|
|
Mechanical
prosthetic valves
|
2.5-3.5
|
Anticoagulation Therapy cont…
INR =
0.98-1.08 INR range
for normal patient
INR =
2.00-3.00 INR range
for anticoagulant therapy
INR = 2.50-3.50 INR
range for high intensity anticoagulant therapy for patients w/ mechanical
valves
Calculations & Equations
FORMULAS
Alveolar-arterial oxygen gradient
A-a gradient= 713*Fio2 -
(pCO2/0.8)-observed pO2
150 -1.2(PaCO2) - PaO2
Normal=10-20 mm Hg or 1/3*pt. age
a/A Ratio:
PaO2 - PAO2
Normal=0.7
Anion Gap:
Na-(Cl + HCO3)
Normal=8-12
Body Water Deficit in liters:
[0.6*wt(kg)]*[pt Sodium- normal
Sodium]
Normal
Sodium
Dilantin Correction:
For low albumin:
Measured
[(0.2 X albumin) + 0.1]
For Creatinine Clearance <10
Measured
[(0.1 X albumin) + 0.1]
MABP
(SBP
+ 2 DBP)
3
or
DBP + [(SBP-
DBP)/3]
Normal = < Prehypertensive
Prehypertension= SBP 120-139 (mm Hg) systolic or 80-89 (mm Hg)
diastolic.
PVR
MPAP-PCWP*80
CO
SVR
MAP-CVP
*80
CO
SV
CO/HR
Creatinine Clearance
(Kg) wt*(140-age)
(72) (plasma creatinine)
70*gms creatinine urine
24h
Serum creatinine
Normal= Male
97-137 mL/min
Female 88-128 mL/min
Fractional
excretion of Na
urine Na/serum Na *100
urine creat/serum
creat
<1=pre-renal >1=renal
Corrected
Calcium
Serum calcium + (0.8)*(4-albumin)
Normal serum=8.0-10.4 mg/dL
PaO2 Predicted
100-(1/3 * age)
Normal=80-105 mmHg
Correction Sodium
Na + [(glucose-100)*0.016]
Sodium Deficit
(Kg)wt *0.6*(140-serum Na)
Plasma Osm
2(Na) serum + (glucose) + (BUN)
18 2.8
Normal=280-300
Ideal body weight
Male: 106 pounds for the first 60
inches then 6 pounds for each additional inch.
Female: 100 pounds for the first
60 inches then 5 pounds for each additional inch.
BSA (m2)
SQUARE ROOT (HT (cm) *wt
(kg) / 3600)
Blood
Sugar:
Sliding scale:
Glucose <0- 60 mg/dL Give
0.5 amp D50 & call House Officer
60- 150 Nothing
151-200 2 Units (U) Novolog/R insulin
201-250 4 U
251-300 6 U
301-350
8 U
351-400 10 U
> 400 Give
12 U & call House Officer
OR:
Give 1 unit Humulin R U100 insulin SQ for every 25
mg/dL over 125, but be careful when treating blood sugar < 200mg/dL.
HbA1c
& Blood Glucose Ratios
% BS
6.0 120
7.0
150
8.0 180
9.0 210
10.0 240
~
1.0% =
30 mg/dL
NORMAL ADULT
LABORATORY VALUES
ABGs
pH 7.35-7.42
PaCO2 35-45 mmHg
PaO2 80-105 mmHg
HCO3- 22-28 mEq/L
O2 sat, art 95-99%
O2 sat, vein 60-85%
Base excess +/-2 mmol/L
Ascitic Fluid
Test
Transudate Exudate
LDH < 200 U/L >200 U/L
LDH
(fluid:serum) < 0.6 >0.6
Protein
< 3 g/dL > 3 g/dL
Protein
(fluid:serum)< 0.5 >0.5
Sp
grav <
1.016 >1.016
Serum:
fluid alb grad > 1.1 g/dL <1.1
g/dL
Fluid
Chol < 45 mg/dL >45 mg/dL
B-HCG
Non-pregnant <5 mIU/mL or IU/L
Gest
age Ref range (mIU/mL)
0-2 wk 0-250
2-4 wk 100-5000
1-2 mo 4000-200,000
2-3 mo 8000-100,000
2nd trimester 4000-75,000
3rd trimester 1000-50,000
CHEMISTRY
Acid Phosphatase
Total 0-10 U/L
Prostatic
<4 U/L
AFP < 10-20 ng/dL
Anion Gap 8-12
mEq/L
Increased: DKA, elevated unmeasured anions, starvation, uremia, phosphatatemia,
sulfate, lactic acidosis, shock, anaerobic glycolysis, Fructose, &
Methanol. Meds: Ethylene Glycol, Paraldehyde, Salicylates, Diuretics,
Penicillin, INH, & Carbenicillin.
Decreased: Dilution,
paraproteinemias, Multiple Myeloma, hypernatremia, hypercalcemia, Bromide &
Lithium.
Albumin: 3.3-5.3 g/dL
Increased: Not seen normally, iatrogenic, dehydration.
Decreased: Severe malnutrition, burns, malabsorption, pregnancy, SLE, RA, Sarcoid, Cystic fibrosis, liver disease,
nephrotic syndrome, thermal burns,
thyrotoxicosis, cancer chemotherapy, pre-eclampsia, Cushing's disease,
familial hypoproteinemia.
Alanine
aminotransferase (ALT, SGPT) 8-40
U/L
Increased: Damaged to hepatocytes, cholangitis, cholestasis,
damage to myocardial cells, damaged erythrocytes, hepatic mets, injury to skeletal
muscle cells.
Decreased: Not clinically significant.
Aldolase 1.3 - 8.2 u/L
Ammonia <45 ug/dL
Antistreptolysin O-titer (ASO)
< 240 µg/L
Aspartate aminotransferase (AST, SGOT) 8-40 U/L
Increased: Acute hepatitis, cirrhosis, cholangitis, EBV, fatty liver, alcohol, PE,
myositis, myocardial cells, trauma, primary biliary cirrhosis, MI, malignant
hyperthermia. Meds: Amiodarone, NSAIDS,
Heparin, Phenytoin, antihypertensive.
Decreased: Not clinically significant.
Alk Phos 30-115 U/L
Alkaline
Phosphatase, serum 20-70 U/L
Increased: During growth, hyperparathyroidism,
fracture healing, osteomalacia, primary & metastatic neoplasms, hepatitis,
cholestasis, Pagets, cirrhosis, DM, Hodgkins, liver mets, sarcoid, bone tumors, Ulcerative Colitis, bowel
perforation, sepsis, IBD, & Thyrotoxicosis.
Decreased:
Pernicious anemia, Celiac Sprue, hypothyroidism,
Scurvy, Kwashiorkor, & hypophosphatesia.
Amylase, Serum
70-180 U/L
Ascorbic Acid 0.4 - 1.5
mg/dL
B12 200-1000 pg/mL
Bicarbonate 22-28
mEq/L
Increased: Respiratory
acidosis. Meds=Thiazides, Ethacrynic
acid, Mercurials, Furosemide, Corticosteroids, & laxatives.
Decreased: Diarrhea, pancreatic fistula, metabolic acidosis
secondary to Ammonium Chloride, Acetazolamide, Ethylene Glycol, Methanol,
Paraldehyde, Metformin & Salicylate poisoning.
Bilirubin,
serum (adult)
Increased: Hepatitis, external compression of the cystic duct,
neoplasms, shock, sepsis, biliary duct obstruction, hemolysis, physiologic
neonatal jaundice, sarcoid, Wilsons dz,
G6PD, Reyes syndrome, Alpha 1 anti-trypsin, Crigler-Najjar syndrome, Cystic Fibrosis,
lymphoma, Gilbert's disease, Dubin-Johnson syndrome, kernicterus, hemolytic
anemia, fatty liver dz, thalasemia & fructose intolerance. Meds: Steroids,
Indomethecin, Halothane, Methyldopa.
Decreased: Iron deficiency anemia.
Total
0.2-1.5 mg/dL (2-17 µmol/L)
Direct
0.0-0.3 mg/dL (0-5 µmol/L)
C-Reactive Protein < 0.8 mg/dL
CA15-5 <20 U/mL
CA125 < 30 U/mL
CEA < 2.5 ng/dL
Ceruloplasmin 23 - 43 mg/dL
Cholesterol
Serum <200 mg/dL
Chol: HDL >35 mg/dL
Chol/HDL
ratio <5
Chol: LDL
<130 mg/dL
Chol: VLDL <40 mg/dL
CO2 content,
blood 24-35 mEq/L (24-35 mmol/L)
CPK
Male 5-175
U/L
Female
5-140 U/L
CPK MB <3-5%
Calcium Ionized 4.25-5.25 mg/dL (1.05-1.30 mmol/L)
Calcium, serum 8.0-10.4 mg/dL (2.0-2.6 mmol/L)
Increased/Hypercalcemia: Sarcoid, sepsis, alkolosis, cirrhosis, Leprosy,
Histoplasmosis, Cushings, adrenal failure, Pheo, hyperthyroidism, primary &
tertiary hyperparathyroidism, hyperphosphatemia, Sarcoidosis, Vitamin D
intoxication, malabsorption, Milk-Alkali syndrome, Paget's disease of bone thyrotoxicosis, acromegaly, & RTAs. Meds:
EDTA, Steroids, Lithium, Vitamin a/e, antacids, DES,
Diuretics, Gentamycin, Phenytoin, Estrogens, Tamoxifen, Progesterone.
Decreased/Hypocalcemia:
Hypoparathyroidism, vitamin D deficiency, renal failure, magnesium
deficiency, acute pancreatitis, massive transfusion, alcoholism. Meds:
Diuretics, Estrogens, Fluorides, Glucose, Insulin, excessive laxatives,
Magnesium salts, Methicillin, & Phosphates.
Calcium Corrected [Norm Alb -Alb of pat]*0.8 + Ca of pat
Chloride 95-106
mEq/L
Increased: Dehydration, diarrhea, Ileal loops, RTA, ARF,
diabetes insipidus, hyperparathyroidism, respiratory alkalosis, &
adrenocortical disorders. Meds=Acetazolamide, ACTH, Androgens, Corticosteroids,
Estrogens, Guanethidine, Salicylate toxicity Methyldopa, Phenylbutazone,
Thiazides, Cholestyramine, Diazoxide, & Triamterene.
Decreased:
Vomiting, NG suction, diarrhea, RF, diuretics, nephropathy, adrenocortical
deficiency, Mineralocorticoid elevation, acid base disorders, Porphyria, &
SIADH, Diabetic coma etc. Meds=D5W, Carbenoxolone, Corticosteroids, Laxatives,
Bicarbonate, & Theophylline.
Copper 70-200 µg/dL
Cortisol, serum
0800 hours
5-23 µg/dL (138-635 nmol/L)
1600 hours
3-15 µg/dL (82-413 nmol/L)
2200 hours
< 50% of 0800 hours
Creatine kinase, serum (at 37deg)
M
55-170 U/L
F
30-106 U/L
Creatinine,
serum 0.6-1.5 mg/dL (53-106 µmol/L)
Increased: Due functional impairment; not altered by dietary
protein intake. Caused by renal insufficiency, proteinuria, ascites, DM, heart
failure, acromegaly, hyperthyroidism, Glucose, Fructose & obesity. Meds=Ascorbic acid, Procainamide, Levodopa,
& Methyldopa.
Decreased: Seen in pregnancy & exercise.
Ferritin, serum
Male
15-250 ng/mL (15-250 µg/L)
Female
12-150 ng/mL (12-150 µg/L)
Fibrinogen
200-400 mg/dL (2.0-4.0 g/L)
Folate 3-12 ng/mL
Gamma-glutamyltransferase (GGT) 10-60 U/L
Increased: Jaudice, fatty liver, cholestasis, hepatitis, cirrhosis, intrahepatic or
extrahepatic obstruction of bile ducts, MI, pneumonia, DM, pancreatitis,
obesity, alcohol hepatitis, mononucleosis, hyperthyroidism, myotonic dystrophy
pancreatic & prostate cancers. Meds:
INH, TCN, Thiazides, Steriods.
Decreased: Not clinically significant.
Glucose,
serum ----- Fasting 60-110 mg/dL (3.3-6.1 mmol/L)
2 hr postprandial <120mg/dL
(< 6.6 mmol/L)
Increased/Hyperglycemia: Symptoms of diabetes plus plasma glucose of >
200 mg/dL OR fasting plasma glucose of >126 mg/dL OR plasma
glucose of 200 mg/dL or at 2 hours following a 75-gram glucose load. Pancreatic tumor, stress, MI, strokes
surgery, trauma, endocrine disorders (Cushings, Conn’s Acromegaly, Pheo),
Caffeine, ETOH, Corticosteroids, Estrogens, Indomethacin, oral contraceptives,
Lithium, Phenytoin, Furosemide, Thiazides, Propanolol, Prazosin, &
Rifampin.
Decreased/Hypoglycemia: Low plasma glucose <50 mg/dL during a symptomatic
episode. Endocrine (adrenal insufficiency, hypothyroidism, liver
dz, renal dz), neoplasms (islet cell tumor, adrenal & gastric carcinoma,
fibrosarcoma, hepatoma), poisonings (arsenic, chloroform, phosphorous, alcohol,
Salicylates, & antihistamines), hypothyroidism, vomiting, trauma, surgery,
functional disorders (postgastrectomy, gastroenterostomy, vagotomy, autonomic
nervous system disorders). Meds=MAOI, NSAIDS, Salicylates, & Warafarin.
Growth Hormone, serum 0-10 ng/mL
IgA 76-390
mg/dL (0.76-3.40 g/L)
IgE 0-380 IU/mL (0-380 kIU/mL)
IgG 700-1500 mg/dL (6.5-15 g/L)
IgM 40-300 mg/dL (0.4-3.45 g/L)
Iron (Fe+2) 50-160 µg/dL (9-30 µmol/L)
Increased: Hemolytic, megaloblastic, & aplastic
anemias, & in hemochromatosis, acute leukemia, lead poisoning, pyridoxine
deficiency, thalassemia, iron therapy, repeated transfusions. Drugs:
Chloramphenicol, Cisplatin, Estrogen, OCPs, Ethanol, Iron Dextran, &
Methotrexate.
Decreased: Iron-deficiency anemia, acute & chronic infections,
carcinoma, nephrotic syndrome, hypothyroidism, & post-op.
Iron saturation 20-55%
Lactate 5-16 mg/dL
Lactate dehydrogenase (LDH) 50-200 U/L
Increased: Clofibrate, Dicumarol, Ethanol, Fluorides, Imipramine, Methotrexate,
Mithramycin, narcotic analgesics, Nitrofurantoin, Propoxyphene, Quinidine,
& Sulfonamides.
Decreased: Not clinically significant.
|
Leucine aminopeptidase (LAP)
|
|
|
Male 80-200
u/ml
Female 75-185 u/ml
|
|
Lipase 5-25 U/L
Magnesium 1.6-2.8 mg/dL (0.7-1.17
mmol/L)
Myoglobin 10-75 ng/mL
Osmolality, serum
274-296 mOsm
[2(Na) + (BUN/2.8) + (Glucose/18)]
O2 saturation 96-100% (0.96-1.00)
Parathyroid hormone, serum, N-terminal (PTH) (230-630
ng/L)
Phosphorus
(inorganic), serum 3.0-4.6 mg/dL (1.0-1.5 mmol/L)
Increased/Hyperphosphatemia: Acute/chronic RF, acromegaly,multiple
myeloma, Paget's, metastases, Addison's disease, hemolysiss, rhabdmyolysis,
volume contraction, leukemia,
sarcoidosis, Milk-Alkali Syndrome, vitamin D excess, healing fractures,
hypoparathyroidism, tumor lysis syndrome, diabetic ketoacidosis. Drugs: Androgens, Furosemide, GH,
Hydrochlorthiazide, oral contraceptives, Parathormone, & Phosphates.
Increased/Hypophosphatemia: RTAs, acidosis, Cushings, sepsis,
hypomagnesemia, hypocalcemia, hypokalemia, malabsorption syndromes, Estrogens,
hyperinsulinism, gout, heat stroke, vomiting, diarrhea,
hyperparathyroidism. Meds:
Acetazolamide, Antacids, Anticonvulsants, Steroids, Citrates, Mannitol,
Oxalate, Tartrate, & Phenothiazines.
Potassium
3.5-5.0 mEq/L
Increased: Acute/chronic RF, crush injuries,
hyperkinetic activity, malignant hyperpyrexia, hemolysis, thrombocytosis,
respiratory acidosis, metabolic acidosis, rhabdomyolysis, & Addison's
disease. Meds: Spironolactone, Amiloride, Triamterene, Histamine, Indomethacin,
Lithium, Mannitol, Methicillin, Aminocaproic acid, Antineoplastic agents,
Epinephrine, Heparin, Beta-blockers, Alpha-agonist, Phenformin, Propranolol,
salt substitutes, Succinylcholine, Tetracycline, NSAIDs & Isoniazid.
Decreased: Vomiting, diarrhea, starvation, bulimia, Cushings, Barter’s
Syndrome, Liddle’s Syndrome, villous adenoma, RTAs, alkalosis & adenoma,
renin secreting tumor, & hypercorticoidism. Meds: Amphotericin, diuretics, Licorice,
Salicylates, Carbenicillin, Carbenoxolone, Steroids, Corticosteroids, &
Ticarcillin.
Prolactin,
serum
Male
<15 ng/mL
Female
<20 ng/mL
Protein, serum
Increased: Para-proteinemia, cirrhosis, elevated albumin,
elevated globulin, volume contraction, multiple myeloma, tumor, Gaucher’s,
venous stasis, OCPs, iron deficiency, DM, inflammation, MI, nephritic syndrome,
dehydration, Sarcoid, & hypergammaglobulinemia.
Decreased: Malnutrition,
low albumin, starvation, pleural exudates, ascites, anorexia, GI tumor, burns,
hemolytic anemia, polydipsia, & pregnancy.
Total
(recumbent) 5.6-7.8 g/dL (55-78 g/L)
Albumin
3.4-5.4 g/dL (35-55 g/L)
Globulins
2.3-3.5 g/dL (23-35 g/L)
PaO2 75-105 mm Hg
PCO2 33-44 mm
Hg
PH 7.35-7.45 mm Hg
PSA <4.0
ng/dL
RPR non-reactive
Sodium 135-147 mEq/L
Increased: Sweating, burns, pancreatitis, Amyliod, Sarcoid,
diarrhea/vomiting, polyuria, Cushings, & low protein intake, Multiple
Myeloma, DI, surgery, poor PO water hydration.
Meds: Mineralocorticoid, Methyldopa, Oxyphenbutazone, Carbenoxolone, Diazoxide,
Reserpine, Guanethidine, Licorice, Sodium Bicarbonate, & Methoxyflurane.
Decreased: Sweating, diarrhea, vomiting, RTA,
Addison’s, diuretic abuse, dilutional, nephrotic syndrome, liver failure,
malnutrition, SIADH, metabolic defects, & reno-tubular. Meds: Diuretics, Cyclophosphamide,
Chlorpropamide, Ammonium Chloride, Corticosteroid, NSAIDS, Vasopressin,
Heparin, Aminoglutethimide, & Vincristine.
Transferrin
200-400 mg/dL
Thyroid-stimulating hormone (TSH)
0.3-4.7 µU/mL
Hypothyroid is >12
Hyperthyroid is < 0.18
Thyroxine (T4),
serum 5-12 µg/dL (64-155 nmol/L)
Increased: Grave’s dz, Hashimoto’s, De Quervain, Strauma
Ovarii, thyroid cancer, HCG secreting tumors.
Meds: Amiodarone, Iodine.
Decreased: Not clinically significant.
TIBC 240-440 µg/dL
Triglycerides
(TG), serum 35-150 mg/dL (0.4-1.81 mmol/L)
Increased:
Primary hypertriglyceridemia, DM, Cushing’s, Gout, CKD, obesity,
hypothyroidism, stress, HTN. Meds: Beta Blockers, Ethanol, Miconazole,
Cholestyramine, Corticosteroids, Thiazides, Glucocorticoids, OCPs,
Spironolactone, & Estrogen.
Decreased: Cachexia,
abetalipoproteinemia, burns, COPD, hyperthyroidism, malnutrition, &
malabsorption states.
Triiodothyronine
(T3), serum (RIA) 115-190 ng/dL (1.8-2.9 nmol/L)
Increased: Hyperthyroidism. Meds: Androgens, Barbiturates,
Chlorpropamide, Corticosteroids, Danazol, Penicillin, Valproic acid.
Decreased: Pregnancy, acute hepatitis, & in
genetically-determined elevations of TBG. Meds: Clofibrate, Lithium,
Methimazole, Proponolol, contrast media, Phenothiazines, Propylthiouracil,
& hypothyroidism.
Free 250-500 pg/dL
Total 75-200 ng/dL
Uptake 22-35%
Troponin 0-0.5 ng/ml
Thyrocalcitonin, serum 115-190 ng/dL (1.8-2.9 nmol/L)
Resin uptake 25-35%
Urea nitrogen,
serum (BUN) 7-21 mg/dL (1.2-3.0 mmol urea/L)
Increased: Decreased
effective circulating blood volume, dehydration, GIB,
or renal perfusion diseases. High protein intake states or obstruction of urine
flow.
Decreased:
High carbohydrate/low protein diets, over-hydration, late pregnancy, infancy,
acromegaly, poor nutrition, mal-absorption, & severe liver damage.
Uric acid,
serum 3.0-7.5 mg/dL (0.18-0.48 mmol/L)
Increased: HPRT,
renal failure, hemolytic dz, psoriasis, liver disease, sarcoidosis, ethanol
consumption. Meds: diuretics, Catecholamines, Ethambutol, Pyrazinamide, &
Salicylates.
Decreased:
Wilson's disease, Fanconi's syndrome, Xanthinuria, Hodgkin's, Multiple Myeloma,
& Bronchogenic Carcinoma.
Zinc 50-150 ug/dL
Complement
C3: 85 - 185 mg/dl
C4: 12 - 5 mg/dl
CH100 60-90 hemolytic units/ml
CEREBROSPINAL
FLUID
Cell count 0-5
cells/mm3 (0-5 x 106/L)
Chloride 118-132 mmol/L
Gamma globulin 3-12%
Glucose 40-80 mg/dL (2.2-3.9 mmol/L)
Leukocytes, Diff
Lymph
60-75%
Mono
25-60%
Neutro
1-3%
Pressure 70-180 mm H2O
Protein, total 10-40 mg/dL
CSF/Meningitis
Normal
Pressure (mmH2O) 500-200
Cells Type Mononuclear
WBCs (cells/mm3) <5
Protein (mg/100ml) 15-45
Glucose (mg/100ml) 45-80
Viral Meningitis
WBC >5 to 1K
Gram stain negative
Culture negative
Blood culture negative
Glucose normal
Protein normal
Some lymphocytes
Bacterial Meningitis
WBC >5 to 60K
Protein 100 - 500
Glucose 5-40
Lactate increased
DRUG LEVELS
|
Drug
|
Therapeutic range
|
Toxic range
|
Acetaminophen
|
Varies
|
>250 mcg/ml
|
Amikacin
|
20-25 mcg/ml
|
>25 mcg/ml
|
Aminophylline
|
10-20 mcg/ml
|
>20 mcg/ml
|
Amitriptyline
|
110-250 ng/ml
|
>500 ng/ml
|
|
Carbamazepine
|
6-12 mcg/ml
|
>12 mcg/ml
|
|
Drugs
|
Therapeutic range
|
Toxic range
|
|
Desipramine
|
115-300 ng/ml
|
>500 ng/ml
|
|
Digoxin
|
0.8-2.0 ng/ml
|
> 2ng/ml
|
|
Disopyramide
|
2-5 mcg/ml
|
>5 mcg/ml
|
Ethosuximide
|
40-100 mcg/ml
|
>100 mcg/ml
|
|
Imipramine
|
150-300 ng/ml
|
>500 ng/ml
|
|
Gentamycin
|
6-10 mcg/ml
|
>12 mcg/ml
|
|
Lidocaine
|
1.5-5.0 mcg/ml
|
> 5 mcg/ml
|
|
Lithium
|
0.6-1.2 mEq/L
|
> 1.6 mEq/L
|
|
Magnesium
|
4-7 mEq/L
|
> 7 mEq/ml |
