Patient Monitoring

Overview

Patient Monitoring and Medical Emergencies covers the moments a patient stops being a positioning problem: the numbers that show someone is in trouble, the tubes and lines they arrive attached to, and the correct first actions when something goes wrong on the table. Study it two ways: recall the numbers cold, and practice picking the correct first action in a scenario.

The numbers come first. Adult pulse runs 60 to 100 beats per minute, with tachycardia above 100 and bradycardia below 60. Respiration is 12 to 20 breaths per minute and oxygen saturation 95 to 100 percent by pulse oximeter. Normal blood pressure is under 120 over 80 mm Hg; current NIH categories call 130 systolic or 80 diastolic high, while Adler's patient care text and older questions put hypertension at 140/90. Oxygen itself is a medication that supports combustion but does not burn, and a simple face mask never runs below 5 LPM because the flow has to flush carbon dioxide out of the mask.

The hardware has one rule per device. An endotracheal tube tip belongs 5 to 7 cm above the carina; a tube pushed too far enters the right main bronchus and collapses the left lung. A chest tube is never clamped and its drainage unit stays below the chest, while a urinary bag stays below the bladder, and its tubing is clamped only if the bag has to be lifted above the patient.

The emergency half covers shock, diabetic events, syncope, seizure, stroke and arrest. In the compensatory stage of shock the blood pressure is still normal while the skin goes cold and clammy, neurogenic shock shows warm dry skin with bradycardia, and hypoglycemia arrives in minutes in the fasting diabetic patient. With early CPR, more than half of patients in ventricular fibrillation survive if the shock comes within 3 to 5 minutes of collapse (Adler's patient care text, 2020); an older patient care text (Torres, 2010) puts the loss at 10 percent for every minute of delay. The chapter closes with scheduling logic: barium studies go last, and the barium enema goes before the upper GI.