NURS 19 Life Threatening Situation

AY 2021-2022 Sir Louis O. Roderos

Midterm Exam 09/11/2021

NURSING RESPONSIBILITIES identify life-threatening emergencies and prioritize

1. ASSESSMENT care.
 assess the patient for subtle changes in condition and
monitor all equipment being used ASSESS AND INTERVENE
 physical and psychological statuses  A systematic approach to effectively establishing and
 may use highly specialized equipment such as treating health priorities is:
cardiac monitors, hemodynamic monitoring  Primary survey approach
devices, and ICP monitoring devices  focuses on stabilizing life-threatening
 laboratory and diagnostic study findings when conditions
assessing a patient  The ED staff work collaboratively and
2. PLANNING follow the ABCDE (airway, breathing,
 consider the patient’s psychological and circulation, disability, exposure) method:
physiologic needs and set realistic patient goals - Establish a patent airway
- Provide adequate ventilation, employing
 anticipate changes in the patient’s condition
resuscitation measures when necessary.
 In planning, be sure to address present and
Patients who have experienced trauma
potential problems, such as:
must have the cervical spine protected
 pain
and chest injuries assessed first,
 cardiac arrhythmias
immediately after the airway is
 respiratory distress
established.
 mental status changes
- Evaluate and restore cardiac output by
 altered hemodynamic states
controlling hemorrhage, preventing and
 impaired physical mobility
treating shock, and maintaining or
 impaired skin integrity
restoring effective circulation. This
 fluid volume deficit.
includes the prevention and management
3. IMPLEMENTATION
of hypothermia. In addition, peripheral
 implement specific interventions to address pulses are examined, and any immediate
existing and potential patient problems. closed reductions of fractures or
 Examples of interventions include: dislocations are performed if an extremity
 monitoring and treating cardiac is pulseless.
arrhythmias - Determine neurologic disability by
 managing pain assessing neurologic function using the
 monitoring responses to therapy. Glasgow Coma Scale (GCS) and a motor
4. EVALUATION and sensory evaluation of the spine
 evaluate a patient’s response to interventions. - A quick neurologic assessment may be
 Use such evaluations to change the care plan as performed using the
needed to make sure that your patient continues - AVPU mnemonic:
to work toward achieving his outcome goals. o A—alert. Is the patient alert and
INFORMATION STATION responsive?
1. DANGER DETAILS o V—verbal. Does the patient respond
 How did the accident occur? to verbal stimuli?
 What type of accident was it? o P—pain. Does the patient respond
 If it was a motor vehicle collision, did the vehicle only to painful stimuli?
sustain exterior or interior damage? o U—unresponsive. Is the patient
2. PATIENT PARTICULARS unresponsive to all stimuli, including
 Was the patient restrained? pain?
 Did the patient have to be extricated from the - Undress the patient quickly but gently so
vehicle? that any wounds or areas of injury are
identified; this may entail cutting away
 Was the patient ambulatory at the scene?
articles of clothing
 If the patient sustained a burn injury, was he found
 Secondary Survey approach
in an enclosed space?
 After these priorities have been addressed,
 If the burn resulted from a fire, was the fire the ED team proceeds with the secondary
accompanied by an explosion? survey. This includes:
3. INJURIES SUSTAINED - Complete health history, including the
 What injuries have the prehospital care providers history of the current event
identified or suspected? - Head-to-toe assessment (includes a
 What are the patient’s chief complaints? reassessment of airway and breathing
4. VITAL VITALS parameters and vital signs)
 What vital signs have care providers obtained - Diagnostic and laboratory testing
before arriving in the ED? - Insertion or application of monitoring
 What treatment has the patient received and how devices such as ECG electrodes, arterial
did he respond? lines, or urinary catheters
5. SYSTEMATIC SYSTEM - Splinting of suspected fractures
 All patients with traumatic injuries should be - Cleansing, closure, and dressing of
assessed rapidly with a systematic method used wounds
consistently for all patients - Performance of other necessary
 The ENA (Emergency Nursing Approach) method interventions based on the patient’s
uses primary and secondary surveys to rapidly condition
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 NURS 19 Life Threatening Situation
AY 2021-2022 Sir Louis O. Roderos
Midterm Exam 09/11/2021
 Once the patient has been assessed, stabilized,
and tested, appropriate medical and nursing
diagnoses are formulated
 the ED nurse must also focus on providing
comfort and emotional support to the patient and
family.
 Effective pain management must be instituted
early and should include rapid-acting agents
 result in minimal sedation so that the patient
can continue to interact with the staff for
ongoing assessment
 Moderate sedation can help facilitate short
procedures in the ED
 the patient will not remember the procedure
later.
 one of the first priorities in emergency care.
 Failure to anticipate potential airway decline or to
successfully ventilate and oxygenate the patient
can lead to hypoxic brain injury or even death.
 The recommended method of establishing a
patent airway in an unresponsive or minimally
responsive patient who is not suspected of having
cervical spine injury is the head-tilt chin-lift.
PRIMARY SURVEY
 begins with an assessment of airway, breathing, and
circulation
 neurologic status—designated as disability (D)
 exposure and environment—designated as E
I. A is for AIRWAY
A. assess a trauma patient’s airway
B. immobilize the cervical spine through initial
stabilization and by applying a cervical collar.
- assume that the patient who has
sustained a major trauma has a cervical
spine injury
C. note whether the patient can speak
- if he can, he has a patent airway
D. Open the airway of an unresponsive patient
with the head-tilt, chin-lift method or with
modified jaw thrust in the trauma patient
E. Check for obstructions to the airway, such as
the tongue, blood, loose teeth, or vomitus.
- Clear airway obstructions immediately
using the jaw-thrust or chin-lift technique
to maintain cervical spine immobilization
- You may need to use suction if blood or
vomitus is present.
F. Insert a nasopharyngeal or oropharyngeal
airway if necessary
- remember that an oropharyngeal airway
can only be used on an unconscious
patient
- An oropharyngeal airway stimulates the
gag reflex in a conscious or
semiconscious patient.
- If a nasopharyngeal or oropharyngeal
airway fails to provide a patent airway,
the patient may require intubation
II. B is for BREATHING
A. Assess the patient for spontaneous
respirations, noting their rate, depth, and
symmetry.
B. Obtain oxygen saturation with pulse oximetry
C. All major trauma patients require highflow
oxygen.
D. If the patient doesn’t have spontaneous
respirations or if his breathing is ineffective,
PERAS, L. LIFE THREATENING SITUATION
ventilate him by using a bag valve mask
device until intubation can be achieved
E. Treatment
- Airway
- O2
- Treat underlying cause
- Support breathing is inadequate
o Bag valve
- Establish continuous monitoring
o Spo2 (pulse oximeter)
III. C is for CIRCULATION
I. Check for the presence of peripheral pulses
II. Determine the patient’s blood pressure.
III. Skin color
IV. Skin temperature
V. All major trauma patients need at least two
large-bore IV lines because they may require
large amounts of fluids and blood
- A fluid warmer should be used if
possible.
VI. If the patient exhibits external bleeding, apply
direct pressure over the site
VII. If he has no pulse, initiate cardiopulmonary
resuscitation immediately.
VIII. Treatment
- Airway, breathing
- Oxygen
- Treat cause
- Fluid challenge
- Inotropes/ vasopressors
- Iv access, take bloods
- Establish ECG monitoring
IV. D is for DISABILITY
A. Perform a neurologic assessment
B. Use the Glasgow Coma Scale to assess the
patient’s baseline status
C. Maintain cervical spine immobilization until X-
rays confirm that there’s no cervical injury
D. If the patient isn’t alert and oriented, conduct
further assessments during the secondary
survey
E. AVPU or GCS – AVPU- alert, verbal, pain,
unresponsive
F. Pupils
G. Lateral sign
H. Glasgow coma scale – 15 ang highest score, 3
lowest = vegetative, <8 comatose
I. Treatment
- ABS
- Treat underlying cause
- Blood glucose
o If <72 mg/dcl (4 mmol/L) give glucose
o D50/50 for hypoglycemia
V. E is for EXPOSURE AND ENVIRONMENT
A. Expose the patient to perform a thorough
assessment
B. Remove all clothing to assess his injuries
- If the patient has bullet holes or knife
tears through his clothing, don’t cut
through these areas
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AY 2021-2022 Sir Louis O. Roderos
Midterm Exam 09/11/2021

- Law enforcement will count on you to

preserve evidence as necessary
C. Environmental control means keeping the
patient warm
- If you’ve removed the patient’s clothes,
cover him with warm blankets.
D. You may need to use an overhead warmer,
especially with an infant or a small child
E. Use fluid warmers when administering large
amounts of IV fluids
- cold patient has numerous problems with
healing

SECONDARY SURVEY
 includes a head-to-toe assessment.
 identifies all injuries sustained by the patient
 At this time, a care plan is developed and diagnostic
tests are ordered.
 Obtain a full set of vital signs initially, including
respirations, pulse, blood pressure, and temperature
 If you suspect chest trauma, get blood
pressures in both arms.
 Next, perform these five interventions:
 Initiate cardiac monitoring.
 Obtain continuous pulse oximetry readings
 readings may be inaccurate if the patient
is cold or in shock.
 Insert a urinary catheter to monitor accurate
intake and output measurements
 Don’t insert a urinary catheter if there’s
blood at the urinary meatus.
 Insert a nasogastric (NG) tube for stomach
decompression.
 Injuries such as a facial fracture
contraindicate the use of an NG tube
 if a facial fracture is suspected, insert the
tube orally instead
 the doctor may insert the NG tube when
a facial fracture is suspected
 Obtain laboratory studies as ordered, such as
type and crossmatching for blood
 complete blood count or hematocrit and
hemoglobin level
 toxicology and alcohol screens, if
On addition information:
ENA and the American Heart Association,
endorse then practice of allowing the patient’s
family to be present during resuscitation
(Emergency Nurses Association [ENA],
2011a).
SAMPLE= To obtain patient history.
indicated
 pregnancy test, if necessary
 serum electrolyte levels
I. FAMILY MATTERS
A. Facilitate the presence of the patient’s family
B. assess the family’s needs before offering
permission to be present
C. Family members may need emotional and
spiritual support from you or from a member of
the clergy
D. If a family member wishes to be present during
resuscitation, assign a health care professional
to explain procedures as they’re performed
PERAS, L. LIFE THREATENING SITUATION
II. A LITTLE TLC
A. During a tense trauma situation, the urgency
of the assessment and treatment processes
may cause you to overlook the patient’s fears
B. talk to the patient and explain the examination
and interventions being administered.
C. An encouraging word and tone can go a long
way to comfort and calm a frightened patient
D. administration of pain medication and
sedation as needed.
III. HISTORY COUNTS
A. Obtain the patient’s history
- to determine the presence of coexisting
conditions, or alcohol or drug use, that
could affect his care or factors that might
have precipitated the trauma
B. perform a head-to-toe assessment
- check all posterior surfaces
- Logroll the patient to assess for injuries
to the back.
C. Address life-threatening injuries immediately.
1. Subjective:
 What does the patient say?
 How did the accident occur?
 Does he remember? What symptoms does
he report?
2. Allergies:
 Does the patient have allergies and, if so,
what’s he allergic to?
 Is he wearing a medical identification
bracelet?
3. Medications:
 Does the patient take medications on a
regular basis and, if so, what medications?
 What medications has he taken in the past
24 hours?
4. Past medical history:
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AY 2021-2022 Sir Louis O. Roderos
Midterm Exam 09/11/2021
 Has the patient been treated for medical
conditions and, if so, which ones?
 Has he had surgery and, if so, what type of
surgery?
5. Events leading to injury:
 How did the accident occur?
 Inquire about precipitating factors, if any.
Assessment of Critically Ill
Types of Information
1. SUBJECTIVE DATA
 Information verbally provided by the client
 Is the patients perception of the problem
 Often put in quotes
 Referred to as the chief complaint
 Pain is highly subjective
2. OBJECTIVE DATA
 Factual
 Things you can see or measure
 Obtained through IPPAS (smell)
 Used to validate subjective complaint
 Done by nurse
Common Airway Adjuncts
I. Oxygen
A. fundamental therapy used to treat many
conditions
B. can be administered by a variety of methods
delivering low to high concentrations
C. Potential side effects include:
1. dryness of the airways and irritation of the
nose, face, or ears from the delivery
device.
II. Oropharygeal Airways
A. is a curved plastic device that is inserted over the
tongue into the posterior pharynx.
B. Used to prevent the tongue or epiglottis from
falling back against the posterior pharynx and
occluding the airway in an unconscious or heavily
sedated patient.
C. Oral airways facilitate suctioning of the pharynx
and prevent patients from biting their tongues or
grinding their teeth. In the intubated patient the
OPA can also serve as a bite block to prevent
biting on the endotracheal tube should not be
used in patients with an intact gag reflex. It may
induce gagging and possible aspiration.
D. The OPA comes in a variety of sizes. To select
the correct size, measure from the corner of the
patient’s mouth to the tip of the earlobe. Be sure
the correct size is used.
E. If the device is too short, it will push the tongue
back and occlude the airway.
F. If the device is too long, it may stimulate gagging
and emesis.
G. There are two methods used for insertion.
1. First, insert the device upside down
(curved side up) until the soft pallet is
reached
2. then rotate the device 180° and advance
over the tongue. Do not use this method in
children.
H. Another method is to use a tongue blade to
depress the tongue and insert the device (curved
side down) into the posterior pharyngeal area.
I. When correctly inserted the plastic flange should
rest against the outer surface of the patient’s teeth
PERAS, L. LIFE THREATENING SITUATION
J. Improperly sized and placed oral and nasal
airways can cause airway obstruction.
III. Nasopharyngeal Airway
I. are made of soft semirigid rubber and are inserted
through a nonobstructed nostril to provide air
passage between the nose and nasopharynx.
II. preferred for conscious patients because it is
better tolerated and less likely to produce a gag
reflex.
III. Select a size that extends from the nares to the
tragus of the ear. If the device is too long, the tip
can stimulate laryngospasm.
IV. Be sure the NPA is well lubricated with a water-
soluble lubricant or topical anesthetic (lidocaine
jelly 2%).
V. Insert it into the nostril with the bevel toward the
septum and advance into the posterior pharyngeal
area.
VI. useful for endotracheal suctioning in the
nonintubated patient and can improve ventilation
when used in conjunction with bag mask
ventilation.
VII. Complications may include epistaxis,
laryngospasm, or vomiting.
VIII. contraindicated in patients who are
anticoagulated, have confirmed or suspected
facial or basilar skull fractures, or have nasal
deformities
IV. Bag-mask Ventilation
A. Manual assisted ventilation is indicated:
1. If the patient becomes apneic
2. If spontaneous ventilation is not effective
3. To reduce work of breathing
4. If patient is hypoxic
B. Successful-bag mask ventilation depends on:
1. Maintaining an open airway
2. Establishing a seal between the patient’s face
and the mask
3. Delivering adequate tidal volume
C. Points to remember when manually ventilating the
patient:
1. Deliver 100% oxygen by maintaining O2 flow
rate of 15 L/min to the resuscitation bag.
2. Deliver ventilations 8 to 10 times per minute,
observing for easy rise and fall of the chest.
3. Excessive tidal volume or airway pressure can
cause gastric distention or pneumothorax.
4. If spontaneous breathing is present,
synchronize bag ventilations with the patient’s
inspiratory efforts.
D. When no cervical spine injury is suspected, use
these procedures for providing bag-mask
ventilation:
1. An oropharyngeal airway or nasopharyngeal
airway may be placed to help maintain a
patent airway.
2. Stand behind the patient’s head and place the
appropriate-sized mask securely on the face.
3. Place the narrow part of the mask at the bridge
of the nose, being careful to avoid pressure on
the eyes. The base of the mask should rest at
the tip of the chin.
4. Stabilize the mask in the left hand with gentle
downward pressure, with the thumb and first
and second fingers on the mask forming a “C”
and the other fingers along the mandible.
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AY 2021-2022 Sir Louis O. Roderos
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5. Compress the resuscitation bag with the right VIII. Administration of a sedation agent prior to
hand, observing for easy rise and fall of the neuromuscular blockade is essential
chest.
E. If cervical spine injury is suspected or if the patient
has a large face or a beard and it is difficult to
maintain a good mask seal:
1. Two-handed technique is preferred.
2. Hold the face mask in place with both hands.
Place the mask against the face and secure
each side of the mask with both hands forming
a “C” on each side.
3. A second operator compresses the
resuscitation bag observing for easy rise and
fall of the chest.

V. Endotracheal Intubation
A. preferred method of airway management in the
apneic patient.
B. two-handed procedure where the provider holds
the laryngoscope in the left hand and positions the
head with the right hand.
C. Once the head is tilted back in position the
trachea is intubated by passing the endotracheal
tube (ETT) through the right side of the mouth and
advancing it to the glottic opening and through the
vocal cords
D. Indications for endotracheal intubation include:
1. Airway protection
2. Relief of obstruction
3. Route for mechanical ventilation and oxygen
delivery
4. Respiratory failure
5. Shock
6. Intracranial hypertension
7. Reduce work of breathing
8. Facilitate suctioning of the airway
E. The role of the assistant during the intubation
procedure:
1. Pass equipment to the airway provider
2. Hold the head in position
3. Hold open the right corner of the mouth during
intubation

VI. Rapid Sequence Intubation

I. begins with preoxygenation and is followed by the
administration of a potent sedative agent and a
rapidly acting neuromuscular blocking agent to
facilitate rapid endotracheal intubation
II. The purpose of RSI is to render the patient
unconscious and paralyzed in order to intubate
the trachea without the need for bag-mask
ventilation, which can cause gastric distension
and risk of aspiration
III. Always give a sedative prior to administering a
neuromuscular blocking agent.
IV. preferred method of preparation prior to intubation
in the conscious patient.
V. not used for patients that are apneic
VI. begins with preoxygenation and is followed by
administration of a series of medications.
VII. The sequential steps are often referred to as the
“seven P’s”:
1. Preparation
2. Preoxygenation
3. pretreatment,
4. paralysis
5. placement
6. placement verification
7. post intubation management

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 NURS 19 Life Threatening Situation
AY 2021-2022 Sir Louis O. Roderos
Midterm Exam 09/11/2021

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 NURS 19 Life Threatening Situation
AY 2021-2022 Sir Louis O. Roderos
Midterm Exam 09/11/2021
FOCUSED HISTORY TAKING MEDICAL MODEL &
FUNCTIONAL INQUIRY
Medical model
 a tried and tested method of assessment
 very similar to the SOAPIE model
 subjective and objective data are collated
 subjective and objective data are collated, the
physical assessment follows and a treatment plan is
devised
I. Presenting complaint
 what has brought the patient to seek help.
 What do they say is wrong with them?
 What are the patient’s symptoms?
II. History of presenting complaint
 use direct questioning to find out:
 When the problem started.
 How it has progressed.
 If they have ever had anything like it
before.
III. Past medical history
 do they have any other illnesses?
 List illnesses in a language the patient
can understand
 Ask if they have ever been in hospital
before.
 Have they had any operations?
IV. Medications and allergies
 ask if they take any medications.
V. Occupation of the patient
 It is important to ascertain what the patient
does or did for a living.
 Certain jobs may increase an individual’s risk
of certain diseases.
VI. Social history
 do not forget to ask about alcohol consumption
 if there is a history of drug abuse and in some
circumstances obtain a sexual history.
 be sensitive and use your clinical
judgement to decide whether or not you
believe these questions are pertinent at
this particular time.
SOCRATES METHOD
 Site if possible, get the patient to show you where it
hurts.
 Onset when did it start? Was it gradual or sudden?
 Character is the pain sharp, stabbing, a heaviness?
 Radiation does the pain go anywhere else?
 Associated features e.g. shortness of breath, nausea,
vomiting, sweating.
 Timing when did it come on? How long have they had it
for?
 Exacerbating/relieving factors what makes It
worse/better, have they taken anything?
 Severity on a scale of 1 10 (10 being the worst).
PERAS, L. LIFE THREATENING SITUATION
FAMILY HEALTH HISTORY
 Age
 Health status
 Age at death and cause of death of relatives
 Family history of blood relatives
FUNCTIONAL INQUIRY
 The functional enquiry is the time when you ask
questions about each of the body systems before you
begin the physical examination.
NURSING CARE FOR PATIENTS UNDERGOING
DIAGNOSTIC PROCEDURE
Diagnostic examination
 It may be performed by a physician at the patient’s
bedside or in a specially equipped room for
therapeutic or diagnostic purposes.
 The nurse’s knowledge and organization of the
diagnostic procedure can be the keys to success.
I. Pretest
 Focus: Client Preparation
 Teaching and communicating with the
patient
 What type of sample is needed
 How will it be collected
 What Equipment to use
 "Does it need fasting prior to the
procedure
 "Does it involve administration of dye
"Are medications given withheld
 Are fluids restricted or forced
 "Is consent required
 "How long is the test
II. Intratest
 Focus: Specimen Collection and performing, or
assisting with certain diagnostic testing
 Uses standard precaution/Sterile technique
as appropriate
 Provides emotional and physical support
 Monitors patient (VS, Pulse oximetry,
ECG, etc.)
 Ensures correct labeling, storage and
transportation of specimen
III. Post Test
 Focus: Nursing care and follow up activities for
the client
 Compares previous and current test results
BLOOD TEST
 Most commonly used diagnostic test
 Provide valuable information about the hematologic
system and many other systems as well
 Venipuncture is performed
BLOOD TESTS THAT DO NOT REQUIRE FASTING
 CBC
 Serum Electrolytes Na, K, Cl, Ca, NHCO3
 Creatinine
 Direct/Indirect Bilirubin
 PT, PTT, APTT
 Drug Monitoring
 Arterial Blood Gas/ CO2 levels
 CK-MB, Trop T and I. Homocysteine, C-Reactive
Protein
 Ferritin
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BLOOD TESTS THAT REQUIRE FASTING 4. Mean corpuscular hemoglobin

Blood Chemistry  average weight of hemoglobin per red cell. Normal
 FBS, BUN level is 27
 Lipid Profile: LDL, HDL, Triglycerides, Total Chole  Normal level is 27 to 311 picograms ( pg ) or 28 33
 Liver Enzymes: AST, ALT, ALP, OGTT, Albumin pg
 Calcium Tests: PTH, Vitamin D, Phosphorus 5. mean corpuscular hemoglobin concentration
 average concentration of hemoglobin per
 Iron Tests: Iron levels, Transferrin saturation
erythrocyte.
 Cardiac Blood Tests: Apolipoproteins  Normal levels ( can be seen with:
 acute blood loss,
 folate and Vitamin B12
NURSING CARE AFTER THE EXTRACTION OF  Hypochromic or “pale cells” will be seen with
BLOOD conditions such as:
 Immediately after blood is drawn, pressure is applied  iron deficiency
(with cotton or gauze) to the puncture site.  thalassemias
 Resume your normal activities and any medications  Normal levels are 32 percent 36 percent.
withheld before the test. 6. Platelets
 Blood may collect and clot under the skin (hematoma)  Platelets help to control bleeding.
at the puncture site  Both platelet number and platelet function play a
 this is harmless and will resolve on its own. role in the effectiveness of the platelet in controlling
 For a large hematoma that causes swelling and bleeding.
discomfort, apply ice initially;  Note that platelet count measures only platelet
 after 24 hours, use warm, moist compresses to help number, not function.
dissolve the clotted blood. 7. White blood cell
 the response to an inflammatory process or injury.
 Normal levels of WBCs for men and women are
COMPLETE BLOOD COUNT 4,300-10,800/cubic mm.
1. Red blood cells  Eosinophils
 Normal levels in men 4.6 million to 5.9 million  found in such areas as skin and the airway in
 women are 4.1 million to 5.4 million, respectively. addition to the bloodstream.
 Low RBC count may indicate:  increase in number during allergic and
 iron deficiency inflammatory reactions and parasite infections.
 blood loss  Normal blood levels range from 0%-7%.
 hemolysis  Basophils
 bone marrow suppression  also known as “mast” cells when found in the
tissues.
 High RBC count may indicate:
 contain heparin and histamine
 when one moves to a higher altitude
 involved in allergic and stress situations.
 after prolonged physical exercise
 contribute to preventing clotting in
 can also reflect the body’s attempt to
microcirculation.
compensate for hypoxia.
 Normal blood levels range from 0% 2 percent.
2. Hemoglobin
 Monocytes
 This blood component carries oxygen from the
 Normal levels, range from 2%-8% 3% to 4%-
lungs to the body tissues.
10%.
 Decreases in hemoglobin occur for the same  Lymphocytes
reasons as decreased RBCs.  fight viral infections
 men 14-18 g/dl.  B cells and T cells
 women are 12-16 g/dl  role in the formation of immunoglobins
3. Mean Corpuscular Volume (humoral
 MCV: This measures the average size of the RBC  immunity) and also provide cellular immunity.
 can be calculated by dividing hematocrit X10 by  Normal levels range from 16%- 45%.
RBC count.
 Normal values are 80-100 fL.
 Low Values may indicate:
 cells are microcytic (small cells)
 iron deficiency
 lead poisoning
 thalassemias
 high values may indicate:
 macrocytic cells (large cells)
 megaloblastic anemia
 folate or Vitamin B12 deficiency
 liver disease
 post splenectomy
 chemotherapy
 hypothyroidism.
 MCV can be normal with a low hemoglobin if the
patient is hypovolemic or has had an acute blood
loss.
PERAS, L. LIFE THREATENING SITUATION 8 of 8