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



Download 0.99 Mb.
Page8/12
Date20.04.2018
Size0.99 Mb.
1   ...   4   5   6   7   8   9   10   11   12

Pancreatitis


Ranson’s Criteria for Pancreatitis Mortality

On Admission:




Age >55

1

WBC > 16

1

Glucose > 200 (>10 SI)

1

LDH > 350

1

AST > 250

1

48 Hours after admission:




HCT drop >10%

1

BUN increase >5 (>1.79 SI)

1

Calcium <8 (<2 SI)

1

Arterial p02 < 60

1

Base deficit (24 - HCO3) > 4

1

Fluid > 6L

1

A score of < 2 is associated with 1% mortality, 3-4, 15% mortality, 5-6, 40% mortality and > 7, 100% mortality.19




TRAUMA




Minor Head Injury



Indications for CT of the head after minor head injury:

New Orleans Criteria

Canadian CT Head Rule

NEXUS2

Headache

Glasgow Coma Score < 15 at 3 hours post injury

evidence of significant skull fracture

Emesis

Possible open or depressed scull fracture

scalp haematoma

Age over 60

Any sign of basal skull fracture

neurologic deficit

Drug or ETOH intoxication

2 or more episodes of vomiting after the injury

altered level of alertness

Seizure

Patient older than 65

abnormal behaviour

Trauma visible above clavicles



coagulopathy

Amnesia for events 30 minutes prior to injury

persistent vomiting

Short Term Memory Deficits

Mechanism of injury was a dangerous activity or event

age 65 or more







New Orleans criteria identified all patients with intracranial injury on CT after minor head injury in patients with loss of consciousness and a GCS 15.20

Canadian CT head rule identified all patients with significant intracranial injury in patients with minor head injury and loss of consciousness. 21



NEXUS2 criteria identified patients with significant intracranial injury and minor head injury and a GCS of 13-15.22

C-Spine



Indications for plain radiographs of the cervical spine after blunt trauma:

NEXUS23

Canadian C-spine Rule24

Midline c-spine tenderness

Midline c-spine tenderness

Abnormal level of alertness

GCS <15

Focal neurologic deficits

Paresthesias of extremities

Evidence of intoxication

Age ≥65 years

Painful distracting injury

Delayed onset of neck pain




Dangerous mechanism

  • fall from elevation ≥ 3 feet / 5 stairs

  • axial load to head, e.g. diving

  • MVC high speed (>100km/hr), rollover, ejection

  • motorized recreational vehicles

  • bicycle struck or collision

  • pushed into oncoming traffic

  • hit by bus / large truck

  • hit by high speed vehicle

Never ambulatory since trauma

Not in sitting position in ED

Unable to actively rotate neck 45° to the left and right



Knee


Indications for plain radiographs of the knee after acute injury:

Pittsburgh25

Ottawa Knee26

Fall or blunt trauma

Tenderness of patella

plus

Tenderness at head of fibula

Inability to ambulate

Inability to flex 90 degrees

or age (younger than 12 or older than 50 years)

Inability to bear weight both immediately and in the emergency department for 4 steps (regardless of limping)



Age ≥65 years



 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.







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