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



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PE/DVT

Pulmonary Embolism


PERC Rule for PE

Age < 50

HR < 100

O2 Sat on Room Air >94%

No Prior History of DVT/PE

No Recent Trauma or Surgery

No Hemoptysis

No Exogenous Estrogen

No Clinical Signs Suggesting DVT

If all of the above 8 criteria are met, the patient has a <2% risk of PE.16

Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2004; 2: 1247–55.
Kline JA, Courtney DM, Kabrhel C, Moore CL, Smithline HA, Plewa MC, Richman PB, O_Neil BJ, Nordenholz K. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost 2008; 6: 772–80.

Wells Rule for PE

Signs & symptoms of DVT

3

Alternative diagnosis less likely than PE

3

Heart Rate > 100

1.5

Immobilization or surgery in past 4 weeks

1.5

History of DVT/PE

1.5

Hemoptysis

1

Malignancy within past 6 months

1







Score > 4 - PE likely. Score 4 or less - PE unlikely. Consider D-dimer to rule out PE.17




Wells Score

PE risk


PLUS Negative D-Dimer


PE Risk

> 4

High Risk




≤ 4



Low Risk ~ 8%



2%


Philip S. Wells, David R. Anderson, Marc Rodger, Jeffrey S. Ginsberg, Clive Kearon, Michael Gent, Alexander G. G. Turpie, Janis Bormanis, Jeffrey Weitz, Michael Chamberlain, Dennis Bowie, David Barnes, Jack Hirsh Derivation of a Simple Clinical Model to Categorize Patients Probability of Pulmonary Embolism: Increasing the Models Utility with the SimpliRED D-dimer Thrombosis and Haemostasis 2000 83 3: 416-420.



Geneva


Simplified Revised Geneva Score

Age 65 years or over

1

Previous DVT or PE

1

Surgery or fracture within 1 month

1

Active malignant condition

1

Unilateral lower limb pain

1

Hemoptysis

1

Heart rate:




75 to 94 beats per minute

1

95 or more beats per minute

1

Pain on deep palpation of lower limb and unilateral edema

1

Patients with a score of 2 or less are considered unlikely to have a current PE. OtherAuthors suggest that the likelihood of patients having a PE with a simplified Geneva score less than 2 and a normal D-Dimer is 3 percent.

Arch Intern Med. 2008;168(19):2131-2136 Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism. Klok FA, Mos IC, Nijkeuter M, Righini M, Perrier A, Le Gal G, Huisman MV.

DVT



Wells Simplified Clinical Model for Assessment of DVT


Active cancer

1

Paralysis, paresis or recent plaster immobilization of lower extremities

1

Recent bedridden >2 days, or surgery within 12 weeks

1

Local tenderness along deep venous system

1

Entire leg swelling

1

Calf swelling 3cm more than asymptomatic leg (10cm below tibial tuberosity)

1

Pitting edema confined to symptomatic leg

1

Collateral superficial veins present

1

Previous DVT

1

Alternative diagnosis at least as likely as DVT

-2



Wells Score

DVT risk


PLUS Negative D-Dimer


3-month DVT Risk

≥3 points

High Risk ~75%




1 or 2 points

Intermediate ~20%

3.5%

0 points

Low Risk 3%

0.5%

The 3-month incidence of DVT with negative D-dimer and low Wells score is 0.5%, and 3.5% with negative D-dimer and intermediate Wells score.





  • Does this patient have deep vein thrombosis? Wells PS, Owen C, Doucette S, Fergusson D, Tran H. JAMA. 2006 Jan 11;295(2):199-207. Review.

  • Diagnosis and treatment of deep-vein thrombosis. Scarvelis D, Wells PS. CMAJ. 2006 Oct 24;175(9):1087-92. Review. Erratum in: CMAJ. 2007 Nov 20;177(11):1392.

  • Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, Kovacs G, Mitchell M, Lewandowski B, Kovacs MJ. N Engl J Med. 2003 Sep 25;349(13):1227-35.



GI

Appendicitis


Appendicitis: MANTRELS Score

M

Migration of pain from umbilicus to right lower quadrant

1

A

Anorexia

1

N

Nausea or vomitting

1

T

Tender right lower quadrant

2

R

Rebound tenderness

1

E

Elevated temprature

1

L

Leukocytosis

2

S

Shift of WBC to the left (increased neutrophils)

1

The two most important factors, tenderness in the right lower quadrant and leukocytosis, are assigned two points, and the six other factors are assigned one point each, for a possible total score of ten points. A score above 6 indicates a probable appendicitis.18
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