Data Collection Form C2T2C2 Case Sheet No.: ___________________________ Age: ________ Estimated weight: ________ Sex M/F Diagnosis: ________________________________________________________________________ iSTAT pCO2 at referring hospital ____________________ iSTAT pCO2 at receiving hospital ____________________ TIME (10 ETCO2 BP (ART. HEART TEMP PtCO2 Vent. Perfusion minute LINE) RATE (earlobe) settings Index intervals)
Data Collection Form C2T2C2 Case Sheet No.: ___________________________ Age: ________ Estimated weight: ________ Sex M/F Diagnosis: ________________________________________________________________________ iSTAT pCO2 at referring hospital ____________________ TIME (10 minute intervals) ETCO2 BP (ART. LINE) HEART RATE TEMP PtCO2 (earlobe) Vent. settings Perfusion Index iSTAT pCO2 at receiving hospital ____________________
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