1 of 2

ECG HR:

SpO2HR:

Temp:

MAP:

ECG Rhythm:

SpO2:

PI:

Masimo

CONTEC

SOC Probe Location:

Wall Mount/Benchtop

Time: 

HgB : 

Study ID/MRN: 

Pleth Quality:  VI/SI/R  ;   PA/VA/GA

Finger Diameter:

Disposable / Reusable / Trauma

Stability:  >30  ;  <30

SpO2:

HR:

PI:

Pleth Quality:  VI/SI/R  ;   PA/VA/GA

Probe Location:

Finger Diameter:

SpO2:

HR:

Pleth Quality:  VI/SI/R  ;   PA/VA/GA

Probe Location:

Finger Diameter:

ECG HR:

SpO2HR:

Temperature:

MAP:

ECG Rhythm:

SpO2:

PI:

Masimo

CONTEC

SOC Probe Location:

Wall Mount/Benchtop

Time: 

HgB : 

Study ID/MRN: 

Pleth Quality:  VI/SI/R  ;   PA/VA/GA

Finger Diameter:

Disposable / Reusable / Trauma

Stability:  >30  ;  <30

SpO2:

HR:

PI:

Pleth Quality:  VI/SI/R  ;   PA/VA/GA

Probe Location:

Finger Diameter:

SpO2:

HR:

Probe Location:

Finger Diameter:

More on the Back

More on the Back

Pleth Quality:  VI/SI/R  ; PA/VA/GA

2 of 2

Ventilation Setting

Type: 

  • None
  • Low flow NC
  • High Flow NC
  • Face Mask w/or w/out Reservoir Bag (Non-Rebreather)
  • Ventilator/CPAP/BiPAP

FiO2:

​

PEEP:

​

Flow Rate:

Vasopressors

(Norepinephrine, Epinephrine, Phenylepi, Dopamine, Dobutamine, Vasopressin, Angiotensin II)

Paralytic Drip

(Atracurium, Cisatracurium, Rocuronium, Vecuroniurn, Pancuronium)

​

  •     None
  • Moderate movement
  • Extreme movement

Note

(Include any notes here, ex. Acrylic nails...etc)

​

Ventilation Setting

Type: 

  • None
  • Low flow NC
  • High Flow NC
  • Face Mask w/or w/out Reservoir Bag (Non-Rebreather)
  • Ventilator/CPAP/BiPAP

FiO2:

​

PEEP:

​

Flow Rate:

Vasopressors

(Norepinephrine, Epinephrine, Phenylepi, Dopamine, Dobutamine, Vasopressin, Angiotensin II)

Paralytic Drip

(Atracurium, Cisatracurium, Rocuronium, Vecuroniurn, Pancuronium)

​

Movement: 

  • None
  • Moderate movement
  • Extreme movoement

Note

(Include any notes here, ex. Acrylic nails...etc)

​

Movement