Scoring systems Flashcards

Question

Australian Heart Foundation Risk Stratification of Chest Pain

Answer 1

HIGH RISK - ST elevation - positive troponin - ongoing/repetitive chest pain - persistent ST depression or TWI in 2 contiguous leads - HD compromise (SBP < 90; killip class >1, and/or new onset MR) - syncope - sustained VT - known poor LV systolic function LVEF <40% - AMI/PCI/CABG within the past 6 months INTERMEDIATE RISK - 2 or more symptomatic episodes within 24 hours - prior regular aspirin use within the past 7 days - age 65+ - CKD - egfr < 60 - known diabetes - known CAD - prior MI w/LVEF > 40%, prior PCI/CABG, coronary lesion >50% - two or more of: HTN, FHx, active smoking, dyslipidaemia LOW RISK - normal ECG - normal TNI - age < 40yrs - absence of known CAD - atypical symptoms - symptoms resolved

Answer 2

STANFORD A - ascending aorta. Can extend distally. Usually needs surgery B - only involves aorta beyond left subclavian. Conservative management. DeBAKEY 1 - entire aorta 2 - confined to ascending aorta 3 - descending aorta distal to subclavian artery

Answer 3

- concordant ST elevation > 1mm in any lead - concordant ST depression > 1mm in any of V1-3 - discordant ST elevation > 5mm

Answer 4

Risk of death and need for ICU ``` S - SBP < 90mmHg M - multilobar CXR involvement A - albumin > 35 R - resp rate > 25 (or > 30 if older than 50yrs) T - tachycardia > 125 C - confusion, acute onset O - oxygen low (<93% if under 50, < 90% if over 50) P - pH < 7.35 (arterial) ``` Predicts risk of needing IRVS + 30 day mortality 5-6 = high risk 7+ = very high

Answer 5

Predicts need for admission ``` C - acute onset confusion U - uraemia (> 7mmol/L) R - resp rate > 30 B - systolic Blood pressure < 90 or DBP < 60 65 - age 65+ ``` ``` 0-1 = appropriate for OPD; 30 day mortality < 3% 2 = 9% mortality; inpatient care 3-5 = 15-40% mortality; consider ICU ```

Answer 6

Estimate probability of PE 7 features - clinical signs and symptoms of DVT (3) - an alternative diagnosis less likely than PE (3) - HR > 100 (1.5) - immobilisation 3+ consecutive days/surgery in the past 4/52 (1.5) - previous objectively diagnosed PE or DVT (1.5) - haemoptysis (1) - malignancy (Rx within past 6/12, or palliative) (1) ``` 0-1 = low risk - consider PERC +/- D dimer 2-6 = moderate risk; consider D dimer or CTPA >6 = high risk - D dimer not recommended ```

Answer 7

PE Rule Out Criteria (need to be low risk for PE on Wells) 8 criteria - age < 50 - pulse < 100 - SpO2 > 95% RA - absence of unilateral leg swelling - absence of haemoptysis - no recent trauma or surgery - no prior history of VTE - no exogenous oestrogen exposure All negative = no need for further workup

Answer 8

PE Severity Index - Age > 80 - history of cancer - chronic cardiopulmonary disease - HR > 110 - SBP < 100 - arterial oxygen saturation < 90% If NO to all --> not high risk. Consider outpatient therapy. (Also consider - pain controlled - not distressed - no bleeding risk - good support and follow up)

Answer 9

As per QLD Health Thrombolysis in STEMI guideline ABSOLUTE - active bleeding or bleeding diatheses (excluding menses) - suspected aortic dissection - significant closed head or facial trauma within 3 months - any prior ICH - ischaemic stroke within 3 months - known cerebral vascular lesion - known malignant intracranial neoplasm RELATIVE - current anticoagulation - non-compressible vascular puncture - recent major surgery (<3 weeks) - traumatic or prolonged CPR - recent internal bleeding (within 4 weeks)/active PUD - suspected pericarditis - advanced liver/advanced metastatic cancer - history of chronic, severe, poorly controlled HTN - severe uncontrolled HTN SBP > 180/DBP > 110 - Ischaemic stroke > 3 months ago - known intracranial abnormality not listed above - dementia - pregnancy or within 1 week post partum

Answer 10

Assist with clinical diagnosis of appendicitis MANTRELS ``` M - migration of pain to RLQ A - anorexia N - nausea and vomiting T2 - tenderness in RLQ R - rebound pain E - elevated temperature L2 - leucocytosis S - shift of WBCs to the left ``` (all score 1 except T and L) 1-4: appendicitis unlikely 5-6: appendicitis possible 7-8: appendicitis probable 9-10: surgery indicated

Answer 11

For use in children aged 3-18 years - RLQ tenderness to cough, percussion, or hopping (2) - anorexia - fever - nausea or vomiting - tenderness over RIF (2) - leukocytosis with WCC > 10 - left shift - migration of pain to the RLQ (all score 1 except RLQ tenderness/pain) ``` 0-3 = unlikely appendicitis 4-6 = consider imaging/surgical consult 7+ = likely appendicitis ```

Answer 12

GCS 13-15 plus at least one of - loss of consciousness - amnesia to the head injury event - witnessed disorientation EXCLUSION - age < 16 years - blood thinners - seizure after injury HIGH RISK criteria (Rules out need for NROS intervention) - GCS < 15 at 2 hours post injury - suspected open or depressed skull fracture - any signs of basilar skull fracture (haemotympanum, raccoon eyes, Battle's sign, CSF pyorrhoea) - 2+ episodes of vomiting - age 65+ MEDIUM RISK (Clinically important brain injury) - retrograde amnesia to event > 30mins - dangerous mechanism (ped v vehicle; ejection; fall from height)

Answer 13

Head CT not required if none of the following are present: - age 65+ - evidence of significant skull # - scalp haematoma - neurological deficit - ALOC - abnormal behaviour - coagulopathy - recurrent or forceful vomiting

Answer 14

- Ages 1-101 included - reduced sensitivity > 65 RULE - ?focal neurological deficit present? - midline spinal tenderness? - altered LOC? - intoxication? - distracting injury? ``` Mnemonic NSAID N - neuro deficit S - spinal midline tenderness A - altered LOC I - intoxication D - distracting injury ```

Answer 15

Exclusions - age 65+ - extremity paraesthesia - dangerous mechanism (fall >0.9m or 5 stairs; axial load injury; high speed MVA or rollover; bicycle collision; motorised recreational vehicle) LOW RISK FACTORS PRESENT? - sitting position in Ed - ambulatory at any time - delayed (not immediate) onset neck pain - no midline tenderness - simple rearend MVC if yes to any of the above... ABLE TO ACTIVELY ROTATE NECK 45d LEFT AND RIGHT? cleared clinically if yes

Answer 16

Inclusion: GCS 14+ ``` UNDER 2 YEARS CT recommended if - GCS 14 - other signs of altered mental status (agitation, somnolence, repetitive questioning, slow response to verbal communications) - palpable skull # ``` Observation recommended if - all of the above absent - occipital or parietal or temporal scalp haematoma - history of LOC 5+ seconds - severe mechanism of injury ``` OVER 2 YEARS CT recommended for same reasons as above Observation recommended for - history of LOC - history of vomiting - severe mechanism of injury - severe headache ```

Answer 17

Fever for at least 5 days Plus FOUR of - conjunctivitis - lymphadenopathy (usually unilateral cervical, tender) - rash - lips and oral mucosa - hyperaemia, strawberry tongue, cracked - extremeties - painful oedema, desquammation NB Irritability often also present, but not part of diagnostic criteria

Answer 18

FEVER plus - sore throat - cervical lymphadenopathy - strawberry tongue - scarlet --> sandpaper rash (12-48 hours after onset of fever)

Answer 19

typically 2-8 years old recent URTI in ~50% - NO FEVER - Palpable purpura - gravity dependent - arthritis/arthralgia (50-75%) - abdominal pain (50%) - renal involvement (haematuria, proteinuria, HTN) (25-50%)

Answer 20

FAT-RN ``` F - fever A - anaemia T - thrombocytopaenia R - renal problems N - neurological problems (more likely in TTP) headache, confusion, seizures ``` **Resembles TTP (same pentad) but renal > neurological Investigations - MAHA - ARF - thrombocytopaenia

Answer 21

Clinical grading of SAH Grade 1 - asymptomatic/minimal headache, slight neck stiffness Grade 2 = moderate-severe headache, neck stiffness, NO neurological features except CN palsy Grade 3 = drowsy, minimal neuro deficit Grade 4 = hemiparesis, stupor Grade 5 = deep coma, decerebrate rigidity, moribund

Answer 22

Clinical grading of SAH Grade 1 = GCS 15, no motor deficit Grade 2 = GCS 13-14, no motor deficit Grade 3 = GCS 13-14, FOCAL neuro deficit Grade 4 = GCS 7-12, with or without focal neuro Grade 5 = GCS < 7, with or without focal neuro

Answer 23

S-A-L-T-ER 1 - S - separated growth plate /slipped 2 - A - above growth plate (most common) 3 - L - beLow growth plate 4 - T - through growth plate (above and below) 5 - ER - ERasure of growth plate (squashed)

Answer 24

STANFORD Type A = ascending aorta. Can extend distally ++. Surgery usually indicated. Type B = only involves aorta beyond L subclavian artery. Conservative/medical Mx. DeBAKEY 1 = entire aorta (60%) 2 = confined to ascending aorta (10-15%) 3 = descending aorta distal to subclavian artery (25-30%)

Answer 25

Severity index for TEN one point for each: - age > 40 - HR > 120 - presence of cancer or haematological malignancy - epidural detachment involving BSA > 10% on day 1 - BUN > 10mmol/L (28mg/dL) - glucose > 14mmol/L - bicarbonate < 20 mEq/L ``` Predicts mortality 0-1 = 3.2% 2 = 12.1% 3 = 35.3% 4 = 58.3% 5+= 90% ```

Answer 26

INCLUSION - alert patient - 15+ years old - new severe atraumatic headache - presenting within 14 days of headache - no head trauma or fall in the previous 7 days EXCLUSION - new neurological deficits - prior aneurysm - prior SAH - known brain tumour - chronic recurrent headache (3+ headaches of the same character and intensity for 6+ months) Why use - 100% sensitive for SAH (rule out tool) - 15% specific - not diagnostic FEATURES - age 40+ - neck pain or stiffness - witnessed LOC - onset during exertion - thunderclap headache (pain peaking within 1 second) - limited neck flexion on examination if yes to any --> cannot exclude SAH; consider SAH workup

Answer 27

M - mask seal (beard, blood on face, disruption of facial continuity) O - obesity/obstruction (angioedema, abscess) A - Age > 55 N - no teeth (leave dentures in place) S - sleep apnoea/stiff lungs (COPD, asthma, ARDS, others)

Answer 28

L - look externally (clinical gestalt, facial disruption, bleeding, small mouth, agitated patient) E - evaluate 332 rule: mouth open, mandible, glottis M - mallampatti score O - obstruction/obesity (4 cardinal signs of upper airway obstruction = stridor, muffled voice, difficulty swallowing secretions, sensation of dyspnoea) N - neck mobility - trauma, arthritis, AS. MILS.

Answer 29

R - restricted mouth opening O - obstruction D - disrupted/distorted airway S - stiff lung or C spine

Answer 30

S - surgery or other airway obstruction H - haematoma (includes infection and abscess) O - obesity R - radiation distortion and other deformity T - tumour

Answer 31

ETT size = age/4 + 4 at lips formula = age/2 + 12cm

Answer 32

Suicide risk ``` S - male sex A - age < 19 or > 45 D - depression P - previous attempt E - excess alcohol or substance abuse R - rational thinking loss S - social supports lacking O - organised plan N - no spouse S - sickness ``` ``` 0-4 = low 5-6 = medium 7-10 = high ```

Answer 33

Mild = PaO2/FiO2 200-300. Mortality = 27% Moderate = PaO2/FiO2 100-200. Mortality = 32% Severe = PaO2/FiO2 < 100. Mortality = 45% (PaO2 on PEEP on 5+)

Scoring systems Flashcards

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