Criteria for being considered unstable:
(1) Glasgow coma scale <= 14
(2) pulse < 60 or > 120 beats per minute
(3) blood pressure < 90 mm Hg after a crystalloid fluid challenge of 2 liters
(4) systolic blood pressure > 190 mm Hg
(5) respiratory rate < 12 or > 24 breaths per minute
(6) poor gas exchange, with oxygen saturation < 90%
(7) temperature < 92°F (< 33°C)
(8) paralysis
(9) hoarseness or inability to talk
(10) labored respirations
(11) severe pain
(12) external hemorrhage
(13) combative
(14) severe deformity involving spine, neck, chest or extremities
(15) penetrating wound from head to popliteal fossa
Comorbid conditions increasing the risk for being unstable:
(1) age > 55 years
(2) history of coronary artery disease
(3) history of COPD
(4) history of liver disease
(5) history of coagulation disorder
(6) history of mental illness
(7) current insulin-dependent diabetes mellitus
(8) current anticoagulation therapy
(9) current pregnancy
where:
• I would think a Glasgow coma score of 14 might be considered stable.
• I would have thought that neonates might also be considered at risk.
