Cns 3 avpu 3 Glasgow Coma Scale 3 Simplified Motor Score 3 Subarachnoid Hemorrhage 4 Intracerebral Hemorrhage Score 4 Stroke Scores 6 nih stroke Scale 6 Modified Rankin Scale 7 tia score 7 Abbreviated mental test score 8 Airway 8


Morbidity & Mortality Scores APGAR



Download 0.99 Mb.
Page12/12
Date20.04.2018
Size0.99 Mb.
1   ...   4   5   6   7   8   9   10   11   12

Morbidity & Mortality Scores

APGAR


Activity/tone

Active +2

Some Extremity Flexion +1

Limp +0

Pulse

>100 BPM +2

<100 BPM +1

Absent +0

Grimace

Sneeze/Cough +2

Grimace +1

None +0

Appearance/Color

All Pink +2

Blue Extremities, Pink Body +1

Blue/Pale +0

Respirations

Good/Crying +2

Irregular/Slow +1

Absent +0

The Apgar score is used to determine which neonates require medical intervention or resuscitation. It is generally done at one and five minutes after birth, and may be repeated later if the score is and remains low. Scores 3 and below are generally regarded as critically low, 4 to 6 fairly low, and 7 to 10 generally normal.28




CPR futility

Medical Arrest


Indications to stop Resuscitation in normothermic adults (all must be met)

Remain pulseless during 10 minute of ACLS

Initial rhythm not shockable

Unwitnessed arrest

It is acceptable to stop resuscitation efforts in the setting of an unwitnessed ventricular fibrillation/tachycardic arrest, in patients who remain pulseless after 10 minutes of CPR.29

Traumatic Arrest


There are currently no adequately sensitive, validated guidelines for determining futility of resuscitation in trauma patients. A small but significant number of patients meet previously published guidelines for termination of resuscitation, 30 but in recent studies have been shown to have survivable injuries, such as pericardial tamponade, tension pneumothorax, airway obstruction or severe hypovolemia.31




SEPSIS in ED


Mortality in Adult ED Patients with Sepsis (MEDS)

Terminal Illness

Metastatic cancer or chronic illness with >50% likelihood of fatality within 28 days

6


Tachypnea/hypoxia

Respiratory rate >20 or Pulse Oximetry <90%

3

Septic Shock

Sepsis plus a systolic blood pressure <90 mm Hg despite a 20–30 ml/kg fluid bolus

3

Platelet count <150 000/mm3




3

Age >65 years




3

Lower respiratory tract infection

Based on clinical findings

2

Nursing home resident




2

Altered mental state

Glasgow coma score <15

2

Total possible score: 24



The risk of death according to the MEDS score is very low (0–4), low (5–7), moderate (8–12), high (12–15) and very high (>15)32


Modified Early Warning Score


Points:

3

2

1

0

1

2

3

Heart Rate




<40

41-50

51-100

101-110

111-129

>130

Respiratory Rate




<9




9-14

15-20

21-29

>30

Systolic BP

<70

71-80

80-100

101-199




>200




Temperature




<35




35-38.4




>38.5




Level of Consciousness

AVPU score












Alert

Reacts to Verbal

Reacts to Pain

Unresponsive

A MEW score greater than 5 is associated with an increased risk of death and indicates a need for ICU admission.33



APACHE-II

Points

Chronic organ insufficiency or immuno-compromise?

Yes

5




Yes & emergent post-op

5

Yes & elective post-op

2

Creatinine


With Acute Renal Failure

<0.6

4




0.6-1.4

0

1.5-1.9

4

2.0-3.4

6

>3.5

8


Without ARF

<0.6

2

0.6-1.4

0

1.5-1.9

2

2.0-3.4

3

>3.5

4

Age

<44

0




45-54

2

55-64

3

65-74

5

> 75 years

6

Temperature (rectal)

< 29.9c

4




30-31.9c

3

32-33.9c

2

34-35.9c

1

36-38.4c

0

38.5-40.9c

1

39-40.9c

3

>40c

4

Mean Arterial Pressure

<49

4




50-69

2

70-109

0

110-129

3

>130

4

Heart Rate

<39

4




40-54

3

55-69

2

70-109

0

110-139

2

140-179

3

>180

4

Respiratory Rate

<5

4




6-9

2

10-11

1

12-24

0

25-34

1

35-49

3

>50

4

Sodium

>180

4




161 – 180

3

156 – 160

2

151 – 155

1

130 – 150

0

120 – 129

2

110 – 119

3

< 110

4

Potassium

>7.0

4




6.1 – 7.0

3

5.6 – 6.0

1

3.5 – 5.5

0

3.0 – 3.4

1

2.5 – 2.9

2

< 2.5

4

Hematocrit

>60

4




51 – 60

2

47 – 50

1

30 – 46

0

20 – 29

2

<20

4

WBC

>40, 000

4




20 - 40,000

2

15 - 20,000

1

3 -15,000

0

1 – 3,000

2

< 1,000

4

GCS

3

4




4 – 6

3

7 – 9

2

10 – 12

1

13 - 15

0

PaO2

< 55

4




55-60

3

61-70

1

>70

0

arterial pH

>= 7.70

4



7.60 – 7.69

3

7.51 – 7.59

1

7.33 – 7.50

0

7.25 – 7.32

2

7.15 – 7.24

3

< 7.15

4



The Apache II Score provides an estimate of ICU mortality using least favorable values from the initial 24 hours in the ICU. For each 5 point increase in Apache II score, there is a significant increase in mortality. Patients with a score of 0-4, have a <2% mortality rate, and patients with a score of >40 have a mortality rate >80%.34

Champion HR, Sacco WJ, et al. Trauma score. Crit Care Med. 1981; 9:672-676.

Wilberger JE. The multiply injured patient. page 15.9. IN: Rengarchy SS, Wilkins RH. Principles of Neurosurgery. Wolfe. 1994.

Brain Death Criteria


Clinical

Diagnostic

Cerebral unresponsiveness

Absent pupillary reflexes

Reversible conditions excluded

Absent corneal reflexes

Body temperature > 32.2ºC

Absent vestibuloocular reflexes

Cause established

Absent gag reflex

Recovery excluded

Absent bronchial reflexes

EEG - Isoelectric

Cerebral blood flow - Absent

Brain death is considered in the presence of coma, central apnea, and areflexia. Clinical evaluation is conducted over a period of time and confirmed by ancillary testing. Testing most commonly includes EEG or cerebral blood flow studies. Cerebral blood flow can be evaluated by angiography or by radioisotope studies

Reversible Conditions Manifesting as Coma


Intoxication

Hypothermia

Shock

Endocrine coma

Metabolic coma

Neuromuscular block

Sedative-induced coma

Analgesic-induced coma





Other

Ramsey Sedation Score

Sedative Agent Monitoring: Ramsay Score



Level

Patient Response




1

Anxious, agitated, or restless

2

Cooperative, oriented, tranquil

3

Quiet, responds to verbal commands

4

Asleep, brisk response to forehead tap or loud verbal stimulus

5

Asleep, sluggish response to forehead tap or loud verbal stimulus

6

Unresponsive, comatose

Components of the ideal sedation scale. As is so often the case, the goal and the reality are far apart, but the goals are laudable. B, Factors of importance and their weighted scores [ref]. Problems with such a list are evident. Thus anxiety, agitation, and restlessness may be associated with pain (relatively easy to address) or hypoxia

CAGE screening test for Problem Drinking



  Have you ever felt the need to

Cut down on drinking? 

  Have you ever felt

Annoyed by criticism of your drinking? 

  Have you ever felt

Guilty about your drinking? 

  Have you ever taken a morning

Eye opener? 

Two "yes" answers are considered a positive screen. One "yes" answer should arouse a suspicion of alcohol abuse.







1 Teasdale G, Jennett B; Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81-4.

2

3 Gill, M., Windemuth, R., Steele, R., Green, S.M. A comparison of the Glasgow Coma Scale score to simplified alternative scores for the prediction of traumatic brain injury outcomesAnnals of Emergency Medicine Volume 45, Issue 1, January 2005, Pages 37-42


4 Haukoos, J.S., Gill, M.R., Rabon, R.E., Gravitz, C.S., Green, S.M. Validation of the Simplified Motor Score for the Prediction of Brain Injury Outcomes After Trauma (2007) Annals of Emergency Medicine, 50 (1), pp. 18-24.
doi: 10.1016/j.annemergmed.2006.10.004

5 Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968; 28:14-20.


6 Ruiz-Sandoval JL, Chiquete E, et al. Grading scale for prediction of outcomes in primary intracerebral hemorrhages. Stroke. 2007; 38: 1641-1644.


7 Emergency and Walls, RM, Murphy, MF, Luten, RC, Schneider, RE. Manual of Emergency Airway Management, 2nd ed, Lippincott Williams and Wilkins, Philadelphia 2004. Copyright ©2004 Lippincott Williams and Wilkins


8 Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adults in the emergency room. Med Decis Making. 1981;1:239-246.

9 Warren J. McIsaac; James D. Kellner; Peggy Aufricht; Anita Vanjaka; Donald E. Low
Empirical Validation of Guidelines for the Management of Pharyngitis in Children and Adults JAMA. 2004;291(13):1587-1595.



10 Westley CR, Cotton EK, Brooks JG. Nebulized racemic epinephrine by IPPB for the treatment of croup. Am J Dis Child. 1978; 132: 484-487.


11 David A. Morrow, Elliott M. Antman, Andrew Charlesworth, Richard Cairns, Sabina A. Murphy, James A. de Lemos, Robert P. Giugliano, Carolyn H. McCabe, and Eugene Braunwald TIMI Risk Score for ST-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation. Circulation 102: 2031-2037


12 Elliott M. Antman; Marc Cohen; Peter J. L. M. Bernink; Carolyn H. McCabe; Thomas Horacek; Gary Papuchis; Branco Mautner; Ramon Corbalan; David Radley; Eugene Braunwald The TIMI Risk Score for Unstable Angina/Non-ST Elevation MI: A Method for Prognostication and Therapeutic Decision Making JAMA. 2000;284(7):835-842.


13 Boersma E, Pieper KS, Steyerberg EW, et al.. Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation. Results from an international trial of 9461 patients. The PURSUIT Investigators. Circulation 2000;101:2557–67


14 Lim WS, Lewis S, Macfarlane JT. Severity prediction rules in community acquired pneumonia: a validation study. Thorax. 2000 Mar;55(3):219-23.


15 Fine, Michael J., Auble, Thomas E., Yealy, Donald M., Hanusa, Barbara H., Weissfeld, Lisa A., Singer, Daniel E., Coley, Christopher M., Marrie, Thomas J., Kapoor, Wishwa N. A Prediction Rule to Identify Low-Risk Patients with Community-Acquired Pneumonia N Engl J Med 1997 336: 243-250


16


17 Does This Patient Have Deep Vein Thrombosis? Philip S. Wells, MD, MSc; Carolyn Owen, MD; Steve Doucette, MSc; Dean Fergusson, PhD; Huyen Tran, MD JAMA. 2006;295:199-207


18 Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986; 15: 557-564

19 Ranson JHC. Etiological and prognostic factors in human acute pancreatitis: A review. Am J Gastroenterol. 1982; 77: 633-638.


20 Haydel MJ, Preston CA, Mills TJ, et. al. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000 Jul 13;343(2):100-5.


21 Stiell IG, Wells GA, Vandenheen K, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001; 357: 1391-6.


22 Mower et al. Developing a Decision Instrument to Guide Computed Tomographic Imaging of Blunt Head Injury Patients. Journal of Trauma. 59(4):954-959, October 2005.


23 Hoffman, JR, Mower WR , and AB Wolfson et al., Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma, N Engl J Med. 343 (2001), pp. 94–99.


24 IG Stiell, GA Wells and KL Vandemheen et al., The Canadian C-spine rule for radiography in alert and stable trauma patients, JAMA 286 (2001), pp. 1841–1848.


25 D.C. Seaberg and R. Jackson, Clinical decision rule for knee radiographs, Am J Emerg Med 12 (1994), pp. 541–543


26 Stiell IG, Greenberg GH, Wells GA, McDowell I, Cwinn AA, Smith NA, et al. Prospective validation of a decision rule for the use of radiography in acute knee injuries JAMA. 1996;275:611-5


27 IG Stiell, GH Greenberg and RD McKnight et al., A study to develop clinical decision rules for the use of radiography in acute ankle injuries, Ann Emerg Med 21 (1992), Volume 21, Issue 4, 1992, Pages 384-390  32, Greenberg

28 Apgar, Virginia (1953). A proposal for a new method of evaluation of the newborn infant. Curr. Res. Anesth. Analg. 32 (4): 260–267. 


29


 Carl van Walraven, Alan J. Forster, and Ian G. Stiell Derivation of a Clinical Decision Rule for the Discontinuation of In-Hospital Cardiac Arrest Resuscitations. Arch Intern Med, Jan 1999; 159: 129 - 134.

30 Hopson LR, Hirsh E, Delgado J, et al. Guidelines for withholding or termination of resuscitation in prehospital traumatic cardiopulmonary arrest: Joint position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma. J Am Coll Surg. 2003;196:106 –112.


31 Pickens JJ, Copass MK, Bulger EM. Trauma patients receiving CPR: predictors of survival.

J Trauma. 2005 May;58(5):951-8. Erratum in: J Trauma. 2005 Nov;59(5):1279-81




32 Shapiro NI, Wolfe RE, Moore RB, et al: Mortality in Emergency Department Sepsis (MEDS) score: A prospectively derived and validated clinical prediction rule. Crit Care Med 2003; 31:670–675

33 Burch, V C, Tarr, G, Morroni, C Modified early warning score predicts the need for hospital admission and inhospital mortality Emerg Med J 2008 25: 674-678


APACHE


34 Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system.(1985). Crit Care Med 13:818–829.

Trauma Score


Respiratory Rate Score10-24425-353> 352< 10100Respiratory EffortShallow1Retracted0Systolic Blood Pressure> 90470-90350-692< 50100Capillary RefillNormal2Delayed1Absent0Glasgow Coma Score14-15511-1348-1035-723-41Trauma ScoreSurvival>13>90%>10> 50%< 8<10%



Share with your friends:
1   ...   4   5   6   7   8   9   10   11   12


The database is protected by copyright ©dentisty.org 2019
send message

    Main page