Apache II General Collection Guidelines: Difference between revisions

Line 30:

* 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?

== Elective Surgery ==

see [[Admit Type for APACHE II]]

=== to do before de-stubbing ===

Used to read:"

ELECTIVE SURGERY- YES or NO

If surgery is an emergency, or if admission type is NON surgical, please answer NO

"

Is this inconsistent with the current instructions?

== Chronic Health ==

see [[Scoring_table#Chronic_Health]]

=== to do before de-stubbing ===

Currently reads in the manual as

"

CHRONIC HEALTH - YES OR NO

Please refer to page 78 of this manual. Can only answer YES if

patient meets strict criteria outlined in this APACHE II table.

"

I don't think the choices are yes/no on the PDA, are they?

== Vital Signs ==

=== Temp ===

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]].

=== BP ===

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.

=== RR ===

Select the the value which gives you the highest score regardless of whether a patient is ventilated or not.

=== HR ===

Select which ever value gives you the highest score. When in atrial fibrillation, do not use this rate, use the ventricular rate.

=== to do before de-stubbing ===

* all are "worst in first 24", right? If so, it is already stated. If stated again, do it for all.

== Neurological Score ==

=== Glasgow Coma Scale ===

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.

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.

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.

==== to do before de-stubbing ====

* what does "best score" mean in this context? Best to make the patient score a high APACHE, or best to let him live?

* in case of sedation or OR, what is the precedence of "alternative" information vs. chart? Are the two not the same?

== Blood Gases ==

Select the '''worst deviation from normal''' Arterial Blood Gases (ABG) as outlined on the APACHE II scoring table. '''Do not use venous gases.'''

FiO2 ≤ 49% - Base your selection of the '''worst''' ABG on the '''worst''' PO2.

FiO2 ≥ 50% - Base your selection of the '''worst''' ABG on the '''worst''' AaDO2.

AaDO2 Calculation:

(AsDO2 is the arterial-alveolar O2 tension difference)

AaDO2 = (Fi02 X 713) - PO2 - CO2

e.g. (FiO2 0.5 X 713) - PO2 85-CO2 40 = AaDO2 231.5

===pH Level===

Independ of the ABG selected, chose the '''worst''' pH from you blood gases.

=== No ABG Availabe Rule ===

If no ABG is available during the first 24 hours in unit use the WORST serum CO2 value.

=== No ABG and no Serum CO2 available ===

Assume normal, record serum CO2 as '''25.0'''

@@ Line 30: / Line 30: @@
 * 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?
+== Elective Surgery ==
+see [[Admit Type for APACHE II]]
+=== to do before de-stubbing ===
+Used to read:"
+ELECTIVE SURGERY- YES or NO
+If surgery is an emergency, or if admission type is NON surgical, please answer NO
+"
+Is this inconsistent with the current instructions?
+== Chronic Health ==
+see [[Scoring_table#Chronic_Health]]
+=== to do before de-stubbing ===
+Currently reads in the manual as
+"
+CHRONIC HEALTH - YES OR NO
+Please refer to page 78 of this manual.  Can only answer YES if
+patient meets strict criteria outlined in this APACHE II table.
+"
+I don't think the choices are yes/no on the PDA, are they?
+== Vital Signs ==
+=== Temp ===
+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]].
+=== BP ===
+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.
+=== RR ===
+Select the the value which gives you the highest score regardless of whether a patient is ventilated or not.
+=== HR ===
+Select which ever value gives you the highest score.  When in atrial fibrillation, do not use this rate, use the ventricular rate.
+=== to do before de-stubbing ===
+* all are "worst in first 24", right? If so, it is already stated. If stated again, do it for all.
+== Neurological Score ==
+=== Glasgow Coma Scale ===
+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.
+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.
+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.
+==== to do before de-stubbing ====
+* what does "best score" mean in this context? Best to make the patient score a high APACHE, or best to let him live?
+* in case of sedation or OR, what is the precedence of "alternative" information vs. chart? Are the two not the same?
+== Blood Gases ==
+Select the '''worst deviation from normal''' Arterial Blood Gases (ABG) as outlined on the APACHE II scoring table. '''Do not use venous gases.'''
+FiO<sub>2</sub> ≤ 49% - Base your selection of the '''worst''' ABG on the '''worst''' PO2.
+FiO<sub>2</sub> ≥ 50% - Base your selection of the '''worst''' ABG on the '''worst''' AaDO2.
+AaDO<sub>2</sub> Calculation:
+(AsDO<sub>2</sub> is the arterial-alveolar O<sub>2</sub> tension difference)
+AaDO<sub>2</sub> = (Fi02 X 713) - PO<sub>2</sub> - CO<sub>2</sub>
+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
+===pH Level===
+Independ of the ABG selected, chose the '''worst''' pH from you blood gases.
+=== No ABG Availabe Rule ===
+If no ABG is available during the first 24 hours in unit use the WORST serum CO<sub>2</sub> value.
+=== No ABG and no Serum CO<sub>2</sub> available ===
+Assume normal, record serum CO<sub>2</sub> as '''25.0'''