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| == When to collect, which value to use == | | == 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 which gives the [[APACHE 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 enhanced symptoms, e.g. BP severely high due to inotropes or 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) |
| === Discussion ===
| | *[[RR]] (Respiratory Rate) |
| * where is this data taken from? [[User:Ttenbergen|Ttenbergen]] 22:34, 4 June 2008 (CDT) | | *[[Arterial blood gas (APACHE)]] |
| | | *[[PH]] |
| '''The following refers to an ongoing discussion, not to a change in collection rules:'''
| | *[[Na]] |
| As discussed in the [[:Category:Critical Care Review Group|Critical Care Review Group]], the last 4 hours in the ER preceeding admission to the ICU may be admissible data for APACHE values if no data is available for the first 24 hours ''in'' ICU. Is this a rule we are using? [[User:Ttenbergen|Ttenbergen]] 13:12, 17 October 2008 (CDT)
| | *[[K]] |
| | | *[[Creatinine (APACHE)]] |
| == Missing Value Rule ==
| | *[[HCT]] |
| '''Do not record the value zero and do not leave any blanks.'''
| | *[[WBC]] |
| | | *[[GCS]] Glasgow Coma Scale |
| If a specific value for any APACHE field is not available in the first 24 hours in ICU then:
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| 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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| {{Discussion}}
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| === Discussion ===
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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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| === 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 ('''[[HR]], [[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: [[temperature]], [[Serum CO2]], [[Na]], [[K]], [[Creatinine]], [[HCT]] and [[WBC]].
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| == Elective Surgery see [[Admit Type for APACHE II]]== | | == Elective Surgery see [[Admit Type for APACHE II]]== |
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| == Chronic Health-see [[Chronic Health Diagnosis for APACHE II]]== | | ==[[Chronic Health APACHE]]== |
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| == Physiological Variable ==
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| === [[Temperature]] ===
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| === [[RR]] (Respiratory Rate) ===
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| === [[HR]]( Heart Rate) ===
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| === [[:Category: ABG | ABG]] Blood Gases ===
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| ===[[PH]] Level===
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| === No ABG Available Rule, see [[serum CO2]]===
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| === mean arterial [[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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| ==== Discussion ====
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| * This refers to an arterial BP. Is that different from a regular BP? [[User:Ttenbergen|Ttenbergen]] 17:14, 25 November 2008 (CST)
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| * These instructions should be moved to [[Mean BP]] and integrated there. [[User:Ttenbergen|Ttenbergen]] 17:14, 25 November 2008 (CST)
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| == Neurological Assessment==
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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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| ==Laboratory Data == | |
| 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. 0.352 record as 35.2
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| * Sodium ([[Na]]), Potassium ([[K]]), [[Creatinine]] are recorded as umols
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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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| == Legacy Data Information == | | ==Acute Renal Failure== |
| *Collected for the '''ICU Program''' since '''June 15, 1988''' and continues to date.
| | see [[ARF (APACHE)]] |
| *Collected for the '''Medicine Program''' from October 1, 2003 to December 31, 2006.
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| | == Related articles == |
| | {{Related Articles}} |
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| [[Category:APACHE II]] | | [[Category:APACHE II]] |
| [[Category:Critical Care Review Group]]
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