Scoring Systems Flashcards
Features of APACHE II
Physiological scores (0-4)
Temperature MAP RR pH PaO2 Na K Cr WCC Hct
Age (upto 6)
Markers of severe organ system deficiency
Markers of severe organ system insufficiency on APACHE II
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
Total points on APACHE II
71
SAPS III features
20 variables
Patient characteristics before admission
Circumstance of admission
Physiological derangement within 1 hour admission
Injury severity scores (ISS)
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
ISS formula
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)
SOFA scoring system
Six organ systems graded 0-4
0 - no dysfunction
1-2 organ dysfunction
3-4 organ failure
SOFA organ features
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
Multiple organ dysfunction score
7 systems
graded 0-4
e.g. composite heart measures = (HR* CVP)/MAP
Therapeutic intervention scoring system (TISS)
Based on nursing workload and therapeutic interventions
28 items
7 groups: Basic activities Vent support CVS support Renal Neuro support Metabolic support Specific intervention
Total score for TISS
78
How much is 1 TISS point worth
10.6 minutes of a nurses time
How many TISS points of activity can one nurse provide per shift
46.35
Lung Injury (Murray Score)
Quadrants involved on CXR
PF ratio
Level of PEEP
Level of static compliance
CURB - 65
Confusion Urea >7 RR>30 BP <90 Age >65
2 points 13%
5 points 57%
Child Pugh score
Bilirubin Albumin PT (INR) Ascites Presence of encephalopathy
MELD
Bilirubin
INR
Creatinine
Maastricht classifcation of death
1 Uncontrolled, DOA, ED
2 Uncontrolled, unsuccessful resus, ED
3 - Controlled, arrested following withdrawel, ICU
4 - Either, Arrest in BSD, ICU
ASA
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
Levels of care (ICS definition)
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,
Grading of hypothermia by severity
Mild 35-32
Moderate 32-28
Severe <28
Hypothermia, swiss staging system
1 - conscious and shivering 2 - impaired consciousness, no shivering 3 - Unconscious 4 - not breathing (VF/asystole) 5 - dead
ASIA classification of spinal injury
A - complete, no motor or sensory
B - Incomplete, sensory but not motor
C - Incomplete, motor function grade 3
E - Normal
The Warkentin 4T system for HIT
Thrombocytopenia
Timing of onset
Thrombosis (or other sequalae)
Other causes of platelet fall
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
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
Normal intra abdominal pressure
5-7mmHg
Intra abdo hypertension grade
I - 12-15
2 - 16-20
3 - 21 - 25
4 >25
Abdominal compartment syndrome definition
IAP >20mmHg PLUS associated organ failure
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
Glascow score (pancreatitis)
PaO2 Age WCC Ca Urea LDH Albumin Glucose
All done at admission
Score of 3 or more - ?critical care
Glascow Blatchford score
Urea
Hb
BP
Other (heart rate, melaena, syncope, liver or cardiac failure)
Rockall score
Age Presence of shock Co-morbid state Diagnosis Evidence of bleeding
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
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
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
