Revisiting The Score - Grand Intern Teaching
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Presented during Intern Teaching in Mercy University Hospital. The purpose of this presentation is to create an awareness of the scores that exist for junior docs. The scores are not absolute. However, they can act as a very good guideline for junior docs. Wan Yusof Wan Jeffery zenslides.com [Eng] presentasipukau.com [Malay]
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Revisiting The Score - Grand Intern Teaching
- 1. Revisiting the Mercy scores University Hospital, Cork Intern teaching | Wan Yusof NE Wan Jeffery
- 3. SIRS
- 4. Feature Value Temperature <36 or >38 Heart rate >90/min RR >20/min or PaCO2<32 mmHg WBC <4 x 10^9/L >12 x 10^9/L
- 5. MEWS
- 6. score of five or more is statistically linked to increased likelihood of death or admission to an intensive care unit. Score 3 2 1 0 1 2 3 increase likelihood of death or admission to an ICU Systolic BP <45% 30% 15% down Normal for patient 15% up 30% >45% >=5 Heart rate (BPM) — <40 41-50 51-100 101-110 111-129 >130 Respiratory rate (RPM) — <9 — 9-14 15-20 21-29 >30 Temperature (°C) — <35 — 35.0-38.4 — >38.5 — AVPU — — — A V P U
- 8. NICE guidelines for head injury
- 13. ABCD2
- 14. Parameter Score Age > 60 1 BP > 140/90 1 Clinical features - Unilateral weakness 2 - Speech disturbance without weakness 1 Duration Lasting >= 1 hour 2 Lasting 10-59mins 1 Diabetes 1
- 16. CHA2DS2VASc
- 18. Score Risk Anticoag 0 Low None / Aspirin 1 Moderate Aspirin / Warfarin >=2 Moderate to High Warfarin
- 20. HAS-BLED
- 24. CURB 65
- 25. Feature Score Confusion (AMT >=8) 1 Urea > 7mmol/L 1 RR >=30/min 1 BP <90/60 1 >=65 1
- 26. 0-1 = Home on AB 2 = Admission / Dc+ ax monitoring 3-5 = Admission +/- ICU Feature Score Confusion (AMT >=8) 1 Urea > 7mmol/L 1 RR >=30/min 1 BP <90/60 1 >=65 1
- 27. Score Mortality(%) 0 0.6 1 3.2 2 13 3 17 4 41.5 5 57
- 28. DVT WELLS PE
- 29. Present Score Lower limb trauma or surgery or immobilisation in a plaster cast +1 Bedridden for more than three days or surgery within the last four week +1 Tenderness along line of femoral or popliteal veins (NOT just calf tenderness) +1 Entire limb swollen +1 Calf more than 3cm bigger circumference,10cm below tibial tuberosity +1 Pitting oedema +1 Dilated collateral superficial veins (non-varicose) +1 Past Hx of confirmed DVT +1 Malignancy (including treatment up to six months previously) +1 Intravenous drug use +3 Alternative diagnosis as more likely than DVT -2
- 30. DVT "Likely" if Well's > 1 DVT "Unlikely" if Wells < 2
- 31. Present Score Clinical Signs and Symptoms of DVT? +3 PE is No. 1 Dx or Equally likley Dx +3 Heart Rate > 100 +1.5 Immobilization at least 3 days, or Surgery in the Previous 4 weeks +1.5 5 Previous, objectively diagnosed PE or DVT? +1.5 Haemoptysis? +1 Malignancy with treatment within 6 months, or palliative? +1
- 32. Wells Score > 4 - PE likely Consider diagnostic imaging Wells Score 4 or less - PE unlikely Consider D-dimer to rule out PE
- 34. Modified Glasgow
- 35. Variable Parameter Score PO2 <8kPa 1 Age >55 1 Neutrophils(WBC) >15 x 10^9/L 1 Calcium(uncorr) <2 mmol/L 1 Renal fn (Urea) >16mmol/L 1 Enzymes (ALT) >100 IU 1 (LDH) >600 IU 1 Albumin <32g/L 1 Sugar(glucose) >10mmol/L 1
- 36. >= 3 severe pancreatitis Variable Parameter Score PO2 >55 1 Age <8kPa 1 Neutrophils(WBC) >15 x 10^9/L 1 Calcium(uncorr) <2 mmol/L 1 Renal fn (Urea) >16mmol/L 1 Enzymes (ALT) >100 IU 1 (LDH) >600 IU 1 Albumin <32g/L 1 Sugar(glucose) >10mmol/L 1
- 37. Hinchey
- 38. Stage Feature(s) Mortality Mn 1 Small, confined pericolic or mesenteric abscesses <5% Ab 2 Larger, confined to the pelvis <5% Ab 3 Perforated, causing purulent peritonitis 13% Sx 4 Ruptured of an uninflamed and unobstructed diverticulum into the peritoneal cavity + faecal contamination 43% Sx
- 40. Activity Mild Moderate Severe No of bloody stools per day <4 4-6 >6 Temp Afebrile Intermediate >37.8 HR(bpm) 60-80 80-90 >90 Hb(g/dl) >11 10.5-11 <10.5 ESR(mm/h) <20 20-30 >30
- 41. Alvarado
- 42. Diagnostic indicants Sensitivity Specificity Migration 0.69 0.84 Anorexia-acetone 0.61 0.72 Nausea-vomiting 0.74 0.36 Tenderness 1.00 0.12 Rebound pain 0.55 0.78 Elevation 0.73 0.50 Leukocytosis 0.93 0.38 Shift of WBC 0.71 0.68 Rectal tenderness 0.53 0.41
- 43. Diagnostic indicants Diagnostic weight Migration 0.72 Anorexia-acetone 0.63 Nausea-vomiting 0.66 Tenderness 0.84 Rebound pain 0.59 Elevation 0.69 Leukocytosis 0.83 Shift of WBC 0.70 Rectal tenderness 0.49
- 44. Diagnostic indicants Value Migration 1 Anorexia-acetone 1 Nausea-vomiting 1 Tenderness 2 Rebound pain 1 Elevation 1 Leukocytosis 2 Shift of WBC 1 Rectal tenderness 1
- 45. Diagnostic indicants Value Migration 1 Anorexia-acetone 1 Nausea-vomiting 1 Tenderness 2 Rebound pain 1 Elevation 1 Leukocytosis 2 Shift of WBC 1 Rectal tenderness 1 <5 unlikely >5 likely
- 46. MANTREL igration to RIF norexia-acetone ausea enderness ebound tenderness levation of T eukocytosis hifts of WBC S
- 48. MANTREL igration to RIF norexia-acetone ausea enderness ebound tenderness levation of T eukocytosis
- 50. thank you revisiting the scores | 27 April 2012
Editor's Notes
- SIRS criteria are very non-specific,[9] and must be interpreted carefully within the clinical context. These criteria exist primarily for the purpose of more objectively classifying critically ill patients so that future clinical studies may be more rigorous and more easily reproducible. The causes of SIRS are broadly classified as infectious or noninfectious. As above, when SIRS is due to an infection, it is considered sepsis. Noninfectious causes of SIRS include trauma, burns, pancreatitis, ischemia, and hemorrhage.[
- quickly determine the degree of illness of a patient It is based on data derived from four physiological readings (systolic blood pressure, heart rate, respiratory rate, body temperature) and one observation (level of consciousness, AVPU). ;
- quickly determine the degree of illness of a patient It is based on data derived from four physiological readings (systolic blood pressure, heart rate, respiratory rate, body temperature) and one observation (level of consciousness, AVPU). ;
- CURB-65, also known as the CURB criteria, is a clinical prediction rule that has been validated for predicting mortality in community-acquired pneumonia[1] and infection of any site.[2] The CURB-65 is based on the earlier CURB score[3] and is recommended by the British Thoracic Society for the assessment of severity of pneumonia.[4]
- Who need CT
- If not- age, anticoagulant, mechanism of injury, LOC
- After TIA to predict the chance of stroke
- Score &gt;= 6 have 8.1% chance of getting stroke within 2 days / 35.5% in the next week Score &gt;4 should be assessed within 24hours by specialist
- Decision for thromboprophylaxis Based on stroke risk
- Decision for thromboprophylaxis Based on stroke risk
- Useful in Assessing the bleeding risk Has predictive value for cardiovascular events + mortality in anticoagulated AF patients
- If HAS-BLED score &gt; 3, the risk of major bleed exceed the risk of thrombotic event
- CURB-65, also known as the CURB criteria, is a clinical prediction rule that has been validated for predicting mortality in community-acquired pneumonia[1] and infection of any site.[2] The CURB-65 is based on the earlier CURB score[3] and is recommended by the British Thoracic Society for the assessment of severity of pneumonia.[4]
- The risk of death at 30 days increases as the score increases:
- Ranson’s criteria – c2h5oh-induced pancreatitis and can only be fully applied after 48h
- Ranson’s criteria – c2h5oh-induced pancreatitis and can only be fully applied after 48h Severe- ICU/HDU
- CURB-65, also known as the CURB criteria, is a clinical prediction rule that has been validated for predicting mortality in community-acquired pneumonia[1] and infection of any site.[2] The CURB-65 is based on the earlier CURB score[3] and is recommended by the British Thoracic Society for the assessment of severity of pneumonia.[4]
- Untreated severe ulcerative colitis shows a mortality of 24% This was reduced to &% with the introduction of IC steroids
- 3 symp 3 signs 2 lab Problem- shifts of WBC in not routinely available
- False negative high in women Sesnitivity only 67% Sensitivity in men 93%