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| == Select the worst value == | | == Physiological variables == |
| Select the physiological values that reflect the '''worst''' deviation from normal in the '''first 24 hours''' in ICU.
| | See [[APACHE physiological variable collection]] for collection instructions. |
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| WORST value could be HIGH or LOW, depending on the one that gives you the [[Scoring_table#Chemistry_values|most points]].
| | See [[APACHE Scoring table]] for a list of variables. |
| Keep in mind the diagnosis and try not to include iatrogenically
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| enhance symptoms, e.g. BP severely high due to inotropes or
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| decreased LOC due to sedation.
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| If the length of stay in ICU is less than 24, use those values only.
| | *[[Temperature]] |
| NOTE: The Higher the APACHE score, the sicker the patient.
| | *[[Mean BP]] mean blood pressure |
| | *[[HR]]( Heart Rate) |
| | *[[RR]] (Respiratory Rate) |
| | *[[Arterial blood gas (APACHE)]] |
| | *[[PH]] |
| | *[[Na]] |
| | *[[K]] |
| | *[[Creatinine (APACHE)]] |
| | *[[HCT]] |
| | *[[WBC]] |
| | *[[GCS]] Glasgow Coma Scale |
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| == Missing Value Rule == | | == Elective Surgery see [[Admit Type for APACHE II]]== |
| '''Do not record the value zero and do not leave any blanks.'''
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| If a specific value for any APACHE field is not available in the first 24 hours in ICU then:
| | ==[[Chronic Health APACHE]]== |
| A) Select a value closest to the time '''prior to''' admission into ICU.
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| Make a note on your collection sheet where the information was obtained from (ER or Ward etc) and from which date and time period it was obtained from.
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| B) If no information is available, then assume it was not tested because it was normal, and record normal values for all APACHE data. Also note this on your collection in your collection notes.
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| === For patients who '''"died" in ICU'''===
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| For patients who '''"died" in ICU''' and have '''no''' data available in ICU to record for an APACHE select the APACHE data that is closest to the time 'prior to' ICU admission ( values from ER, ward, etc.).
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| If these are NOT available then:
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| 1. For vital signs ('''Pulse, BP mean, RR only'''), select the lowest limit value on the APACHE table that will give you the highest score.
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| 2. Record '''normal''' values for: TEMP, CO2, NA, K, Creat, HCT and WBC.
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| === To do before de-stubbing ===
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| * there is reference to "the collection sheet" - does that mean we need to track this electronically? If not, why do we need to take this down? Or do we, still?
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| == Elective Surgery ==
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| see [[Admit Type for APACHE II]]
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| === to do before de-stubbing ===
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| Used to read:"
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| ELECTIVE SURGERY- YES or NO
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| If surgery is an emergency, or if admission type is NON surgical, please answer NO
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| "
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| Is this inconsistent with the current instructions?
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| == Chronic Health ==
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| see [[Scoring_table#Chronic_Health]]
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| === to do before de-stubbing ===
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| Currently reads in the manual as
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| "
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| CHRONIC HEALTH - YES OR NO
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| Please refer to page 78 of this manual. Can only answer YES if
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| patient meets strict criteria outlined in this APACHE II table.
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| "
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| I don't think the choices are yes/no on the PDA, are they?
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| == Vital Signs ==
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| === Temp ===
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| Select the '''worst''' value in the first 24 hours in ICU., i.e. the value that would generate the highest score on the [[Scoring_table#Chemistry_values]].
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| === BP ===
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| Look carefully when selecting this value. APACHE II score is based on the '''worst''' calculated mean BP (either high or low) which ever gives you the highest points as per scoring table, but you must also take in account the diagnosis. For example if a patient is in septic shock, you would want the lowest BP as opposed to the highest BP that is artificially enhanced by inotropes.
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| === RR ===
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| Select the the value which gives you the highest score regardless of whether a patient is ventilated or not.
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| === HR ===
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| Select which ever value gives you the highest score. When in atrial fibrillation, do not use this rate, use the ventricular rate.
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| === to do before de-stubbing ===
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| * all are "worst in first 24", right? If so, it is already stated. If stated again, do it for all.
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| == Neurological Score ==
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| === Glasgow Coma Scale ===
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| For Head traumas select the '''worst''' score in the first 24 hours in ICU. If sedated or paralyzed select the '''best''' score in the first 24 hours in ICU prior to sedation.
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| For non neuro & post operative patients who are sedated or paralyzed, please record a '''normal''' neuro score, unless there is a neurological problem. If this is the case, you must select the select the '''worst''' values prior to sedation or “best guess” based on history prior to sedation.
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| Sedation does not allow us to accurately assess Neuro status, therefore we use alternative information that was documented prior to OR or sedation or we use our “best guess” base on chart notes.
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| ==== to do before de-stubbing ====
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| * what does "best score" mean in this context? Best to make the patient score a high APACHE, or best to let him live?
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| * in case of sedation or OR, what is the precedence of "alternative" information vs. chart? Are the two not the same?
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| == Blood Gases ==
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| Select the '''worst deviation from normal''' Arterial Blood Gases (ABG) as outlined on the APACHE II scoring table. '''Do not use venous gases.'''
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| FiO<sub>2</sub> ≤ 49% - Base your selection of the '''worst''' ABG on the '''worst''' PO2.
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| FiO<sub>2</sub> ≥ 50% - Base your selection of the '''worst''' ABG on the '''worst''' AaDO2.
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| AaDO<sub>2</sub> Calculation:
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| (AsDO<sub>2</sub> is the arterial-alveolar O<sub>2</sub> tension difference)
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| AaDO<sub>2</sub> = (Fi02 X 713) - PO<sub>2</sub> - CO<sub>2</sub>
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| e.g. (FiO<sub>2</sub> 0.5 X 713) - PO<sub>2</sub> 85-CO<sub>2</sub> 40 = AaDO<sub>2</sub> 231.5
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| ===pH Level===
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| Independ of the ABG selected, chose the '''worst''' pH from you blood gases.
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| === No ABG Availabe Rule ===
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| If no ABG is available during the first 24 hours in unit use the WORST serum CO<sub>2</sub> value.
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| === No ABG and no Serum CO<sub>2</sub> available ===
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| Assume normal, record serum CO<sub>2</sub> as '''25.0'''
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| ==Laboratory Data ==
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| Select the WORST deviation from normal during the first 24 hours in ICU.
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| * Hematocrit (HCT) is recorded as a percentage, e.g. 0.0352 record as 35.2
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| * Sodium (NA), Potassium (K), Creatinine are recorded as mmols
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| * White Blood Count (WBC) record per 1000 e.g. 10.0
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| Also see: [[General_Collection_Guidelines_for_Apache_II#Missing_Value_Rule|Missing Value Rule]]
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| ===to do before de-stubbing ===
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| wouldn't the percentage be 3.52?
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| ==Acute Renal Failure== | | ==Acute Renal Failure== |
| '''Yes''' is recorded only if '''both''' of the following criteria as outlined by APACHE II are met:
| | see [[ARF (APACHE)]] |
| * Creatinine value is ≥ 133 mmols
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| '''and'''
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| * Urine Output is ≤ 135 cc in an 8 hour period during the first 24 hours in unit.
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| APACHE points are doubled if YES is recorded
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| '''No'''is recorded for all other cases including those patients who have history of Chronic Renal Failure (CRF) and are on dialysis.
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| ===to do before de-stubbing ===
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| * is it no or yes for a CRF patient who happens to meet the "yes" requirements?
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| == To do before de-stubbing ==
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| * get rid of all sub-heading de-stubs
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| == To do before de-stubbing ==
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| * address other de-stubs above
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| * finish moving from paper
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| | == Related articles == |
| | {{Related Articles}} |
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| {{stub}}
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| [[Category:APACHE II]] | | [[Category:APACHE II]] |