24 - Clinical Scoring Systems Flashcards
What is the treatment for a DVT and how soon should you start it?
- Rivaroxaban/Apixaban or LMWH
- Needs to be started within 4 hours, if cannot do US or D-dimer in this time start interim. If confirmed need at least 3 months treatment
- Take clotting screen, FBC, LFTs, U+Es before anticoagulation but do not wait for results
What are some important medications to remember to put on a prescription for a newly admitted patient?
- Oxygen
- 5000 units dalteparin
- Paracetamol PRN
- Cyclizine PRN
How do you document a ward round?
- Age
- Admitted with
- Background
- Bloods and EWS
- SOAP
How do you calculate a GCS score? (learn image of by heart)
- Eyes 4
- Verbal response 5
- Motor response 6
How do you interpret a GCS score?
How do you calculate a CURB 65 score and interpret it?
C - Confusion
U- Urea >7
R- RR>30
B - Sys <90 or Dias <60
65 years old
1 = outpatient treatment
2 = consider inpatient or outpatient treatment with close follow up
>3 = inpatient treatment with possible ICU referral
How do you calculate and interpret a Centor score?
Works out the likelihood a pharyngitis is due to Group A strep
- Age
- Exudate
- Swollen lymph nodes
- Fever
- Cough
Score of 1 or less no test or treatment
Score of 2 then rapid antigen test but not treat
Score of 3 or more then rapid antigen test and treat empirically
How do you calculate and interpret a FeverPAIN score?
- Fever in last 24 hours
- Purulence
- Attend rapidly <3 days
- Inflammed tonsils
- No cough or coryza
Score of 1 then no antibiotics
Score of 2-3 consider delayed antibiotics
Score of 4-5 then antibiotics needed
How do you calculate and interpret a CHA2DS2-VASc score? (memorise image)
Calculates the stroke risk of a patient with AF
- Score of 0 (male) or 1 (female) then no anticoagulation
- Score of 1 (male) then anticoagulation recommended
- Score of 2 or more then anticoagulant
What is the BTS classification of asthma severity?
Moderate acute - PEF >50-75% best or predicted, no features of acute severe
Acute Severe - PEF >33-50%, RR>25, cannot speak in full sentences, HR>110
Life threatening - Silent chest, Normal pCO2, PEF<33% or cannot do, sats <92%, altered consciousness, pO2 <8, exhaustion, arrhythmias, hypotension
Near fatal - Raised pCO2
What is the MRC dyspnea scale?
1 - Breathless on strenuous exertion
2 - Breathless when hurrying on the level or walking up a slight hill
3 - Breathless compared to same age on level ground or has to stop for breath when walking at own pace
4 - Stops for breath after walking 100m
5 - Too breathless to leave house or dress self
What are the different stages of CKD?
Stage 1 - Normal eGFR>90 with proteinuria so kidney damage
Stage 2 - eGFR 60-90 with proteinuria
Stage 3 - eGFR 30-60
Stage 4 - eGFR 15-30
Stage 5/ESRD - eGFR<15
What is the MRC grading of muscle power?
0 - no contraction
1 - flicker or trace of contraction
2 - movement with gravity eliminated
3 - movement against gravity
4 - movement against gravity and resistance
5 - normal power
How do you calculate a Wells score for DVT and how do you interpret the results? (remember criteria)
Score of 1 or less DVT is unlikely, do a D-Dimer
Score of 2 or more DVT is likely, do a doppler US
How do you calculate a Wells score for PE and how do you interpret the results? (remember criteria)
Score of 4 or less then PE unlikely
Score over 4 then PE likely
How does a NEWS score inform a management plan?
- Decides frequency of observations
- Decides who to escalate to
What are the different ASA grades? Give some examples of patients that would fit into each grade.
Helps to work out a patient’s fitness for anaesthesia and the risk of perioperative complications
What is the HAS-BLED score for and how do you interpret it?
Assess 1-year risk of major bleeding in people taking anticoagulants for atrial fibrillation
- Low risk for major bleed = 1 or less
- Moderate risk for major bleed = 2
- High risk for major bleed = 3-5
- Very high risk for major bleed = 6 or more
What is the Rockall score for and how do you interpret it?
Identify patients at risk of rebleeding or death following acute upper GI bleed
Looks at clinical bleeding AND endoscopy results
- <3 low risk of rebleeding
- 6 or more then surgery indication
- 8 or more high risk of mortality
What is the P-POSSUM score for?
Used to predict morbidity and mortality for general surgery (not for trauma patients)
Looks at both patient and operative factors
What is the NELA score?
Calculate risk of death within 30 days of emergency laparotomy abdominal surgery
What is the Ranson score and how do you interpret the score?
Used to predict the severity and mortality of acute pancreatitis
Looks at age, WBC, glucose, LDH and AST on admission then 48 hours later looks at more parameters
What is the ROME IV score for IBS and how do you interpret it?
Patients with symptoms of IBS, such as chronic and recurrent abdominal pain and/or altered bowel habits for at least 6 months
What is the ROME IV score for constipation and how do you interpret it?
Diagnoses constipation, looks at stools being constipated 25% of the time
