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Pete FFICM SOE/OSCE > Gen - Scoring Systems > Flashcards

Gen - 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 (Simplified Acute Physiology Score 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 score (Model for End-Stage Liver Disease)

A

Bilirubin
INR
Creatinine

18
Q

The Maastricht classification of Donation after Circulatory 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
Q

Fisher scale of SAH

A

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
Q

World Federation of Neurologists SAH grade

A 
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
Q

Normal intra abdominal pressure

A

5-7mmHg

28
Q

Intra abdo hypertension grade

A

I - 12-15
2 - 16-20
3 - 21 - 25
4 >25

29
Q

Abdominal compartment syndrome definition

A

IAP >20mmHg PLUS associated organ failure

30
Q

Ranson score

A 
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
Q

Glascow score (pancreatitis)

A 
PaO2 
Age
WCC
Ca
Urea
LDH
Albumin
Glucose

All done at admission
Score of 3 or more - ?critical care

32
Q

Glascow Blatchford score

A

Urea
Hb
BP
Other (heart rate, melaena, syncope, liver or cardiac failure)

33
Q

Rockall score

A 
Age
Presence of shock
Co-morbid state
Diagnosis
Evidence of bleeding
34
Q

Definition of hepato-renal syndrome

A 
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
Q

King Criteria - Paracetamol

A

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
Q

King Criteria - non paracetamol

AKA O Grady score

A

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

Pete FFICM SOE/OSCE (199 decks)

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