Scoring Systems Flashcards

1
Q

Features of APACHE II

A

Physiological scores (0-4)

Temperature
MAP
RR
pH 
PaO2
Na
K
Cr
WCC
Hct

Age (upto 6)

Markers of severe organ system deficiency

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2
Q

Markers of severe organ system insufficiency on APACHE II

A

Liver: biopsy cirrhosis with portal BP
Previous Upper GI bleeds

CVS - NHYA failure score class 4

Resp - obstructive, restrictive diseases leading to exercise restriction

Renal - chronic dialysis

Immunocompromised

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3
Q

Total points on APACHE II

A

71

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4
Q

SAPS III features

A

20 variables

Patient characteristics before admission
Circumstance of admission
Physiological derangement within 1 hour admission

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5
Q

Injury severity scores (ISS)

A

APACHE has less predictive value for trauma

Trauma is usually younger and therefore less co-morbid

ISS based on regions
Head and neck
Face
Thorax
Abdomen and visceral pelvis
Bony pelvis and extermities
External structures (sin)

And the most severely injury in each area is graded 1-6
1 - minor
6 - Unsurvivable

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6
Q

ISS formula

A

Take the three most seriously injured regions.
Score them

ISS = (A squared) + B squared + C squared

Total score is 75 (because any score of 6 automatically defaults to 75)

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7
Q

SOFA scoring system

A

Six organ systems graded 0-4

0 - no dysfunction
1-2 organ dysfunction
3-4 organ failure

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8
Q

SOFA organ features

A
RR - P/F ratio
CVS - composite of MAP and degree of phrama support
Neuro: GCS
Renal: creatinine or daily U/O
Liver: bilirubin
Coag: platelets

Record worst value of the day

Was NOT designed to predict mortality

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9
Q

Multiple organ dysfunction score

A

7 systems
graded 0-4

e.g. composite heart measures = (HR* CVP)/MAP

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10
Q

Therapeutic intervention scoring system (TISS)

A

Based on nursing workload and therapeutic interventions

28 items

7 groups:
Basic activities
Vent support
CVS support
Renal
Neuro support
Metabolic support
Specific intervention
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11
Q

Total score for TISS

A

78

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12
Q

How much is 1 TISS point worth

A

10.6 minutes of a nurses time

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13
Q

How many TISS points of activity can one nurse provide per shift

A

46.35

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14
Q

Lung Injury (Murray Score)

A

Quadrants involved on CXR
PF ratio
Level of PEEP
Level of static compliance

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15
Q

CURB - 65

A
Confusion
Urea >7
RR>30
BP <90
Age >65

2 points 13%
5 points 57%

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16
Q

Child Pugh score

A
Bilirubin
Albumin
PT (INR)
Ascites
Presence of encephalopathy
17
Q

MELD

A

Bilirubin
INR
Creatinine

18
Q

Maastricht classifcation of death

A

1 Uncontrolled, DOA, ED
2 Uncontrolled, unsuccessful resus, ED
3 - Controlled, arrested following withdrawel, ICU
4 - Either, Arrest in BSD, ICU

19
Q

ASA

A

1 - normal, healthy
2 - mild systemic disease without functional limit
3 - severe systemic disease with substantial functional limit
4 - Severe disease that is a constant threat to life
5 - moribund not expected to survive without op (ruptured AAA, ischaemic bowel, MOFD)
6 - BSD for organ donation

20
Q

Levels of care (ICS definition)

A

0 - needs can be met through normal ward care
1 - patient at risk of deteriorating, or recently stepped down, whose needs can be met on acute ward with addtional CCOT
2 - Patients needing detailed observation, intervention, support for single organ failure or post op care
3 - Advanced resp support, or two organ failure,

21
Q

Grading of hypothermia by severity

A

Mild 35-32
Moderate 32-28
Severe <28

22
Q

Hypothermia, swiss staging system

A
1 - conscious and shivering
2 - impaired consciousness, no shivering
3 - Unconscious
4 - not breathing (VF/asystole)
5 - dead
23
Q

ASIA classification of spinal injury

A

A - complete, no motor or sensory
B - Incomplete, sensory but not motor
C - Incomplete, motor function grade 3
E - Normal

24
Q

The Warkentin 4T system for HIT

A

Thrombocytopenia
Timing of onset
Thrombosis (or other sequalae)
Other causes of platelet fall

25
Fisher scale of SAH
1 - no blood 2 - Diffuse disposition without clots or layers>1mm 3 - Localised clots and or vertical layers of blood >1mm 4 - Diffuse or not Sub arch blood, but intracerebral/intraventricular clots
26
World Federation of Neurologists SAH grade
``` 1 - GCS 15, no motor deficit 2 - GCS 13-14 no motor deficit 3 - 13-14 with motor deficit 4 - 7-12 irrespective motor 5 - 3-6 irrespective ```
27
Normal intra abdominal pressure
5-7mmHg
28
Intra abdo hypertension grade
I - 12-15 2 - 16-20 3 - 21 - 25 4 >25
29
Abdominal compartment syndrome definition
IAP >20mmHg PLUS associated organ failure
30
Ranson score
``` Admission Age>55 AST ?250 Glucose > 11.2 WCC >16 LDH>350 ``` ``` 24 hours Fall in Hct >10% PaO2 >8 BE 4 Fluid sequestriation 6 litres Rise in urea >1.8 ```
31
Glascow score (pancreatitis)
``` PaO2 Age WCC Ca Urea LDH Albumin Glucose ``` All done at admission Score of 3 or more - ?critical care
32
Glascow Blatchford score
Urea Hb BP Other (heart rate, melaena, syncope, liver or cardiac failure)
33
Rockall score
``` Age Presence of shock Co-morbid state Diagnosis Evidence of bleeding ```
34
Definition of hepato-renal syndrome
``` Cirrhosis with ascites Creatinine >133 No improvement in creatinine after 2 days of dieretic withdrawel and volume expansion with albumin Absence of shock No current/recent nephrotoxic use Absence of parenchymal renal disease ```
35
King Criteria - Paracetamol
pH<7.3 24 hours after fluid resus OR Enceph grade 3/4 PT >100 (INR 6.5) Creatinine >300 OR lactate 3.5 at 4 hours OR lactate 3 at 12 hours
36
King Criteria - non paracetamol | AKA O Grady score
PT > 100 OR Any three of ``` PT>50 Non hep A/B aetiology Age <10 or >40 Bili >300 Duration of jaundice prior to enceph >7 days ```