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APACHE II
APACHE II ("Acute Physiology and Chronic Health Evaluation II") is a severity-of-disease classification system, one of several ICU scoring systems. It is applied within 24 hours of admission of a patient to an intensive care unit (ICU): an integer score from 0 to 71 is computed based on several measurements; higher scores correspond to more severe disease and a higher risk of death. The first APACHE model was presented by Knaus et al. in 1981. Application APACHE II was designed to measure the severity of disease for adult patients admitted to intensive care units. It has not been validated for use in children or young people aged under 16. This scoring system is used in many ways which include: # Some procedures or some medicine is only given to patients with a certain APACHE II score # APACHE II score can be used to describe the morbidity of a patient when comparing the outcome with other patients. # Predicted mortalities are averaged for groups of patients in order to spec ...
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Intensive Care Unit
An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensive care medicine. An intensive care unit (ICU) was defined by the task force of the World Federation of Societies of Intensive and Critical Care Medicine as "an organized system for the provision of care to critically ill patients that provides intensive and specialized medical and nursing care, an enhanced capacity for monitoring, and multiple modalities of physiologic organ support to sustain life during a period of life-threatening organ system insufficiency." Patients may be referred directly from an emergency department or from a ward if they rapidly deteriorate, or immediately after surgery if the surgery is very invasive and the patient is at high risk of complications. History In 1854, Florence Nightingale left for the Crimean War, where triage was used ...
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Creatinine
Creatinine (; ) is a breakdown product of creatine phosphate from muscle and protein metabolism. It is released at a constant rate by the body (depending on muscle mass). Biological relevance Serum creatinine (a blood measurement) is an important indicator of kidney function, because it is an easily measured byproduct of muscle metabolism that is excreted unchanged by the kidneys. Creatinine itself is produced via a biological system involving creatine, phosphocreatine (also known as creatine phosphate), and adenosine triphosphate (ATP, the body's immediate energy supply). Creatine is synthesized primarily in the liver by methylation of glycocyamine (guanidino acetate, synthesized in the kidney from the amino acids arginine and glycine) by S-adenosyl methionine. It is then transported in the blood to other organs, muscles, and the brain, where it is phosphorylated to phosphocreatine, a high-energy compound. Creatine conversion to phosphocreatine is catalysed by creatine ki ...
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ASA Physical Status Classification System
The ASA physical status classification system is a system for assessing the fitness of patients before surgery. In 1963 the American Society of Anesthesiologists (ASA) adopted the five-category physical status classification system; a sixth category was later added. These are: #Healthy person. #Mild systemic disease. #Severe systemic disease. #Severe systemic disease that is a constant threat to life. #A moribund person who is not expected to survive without the operation. #A declared brain-dead person whose organs are being removed for donor purposes. If the surgery is an emergency, the physical status classification is followed by "E" (for emergency An emergency is an urgent, unexpected, and usually dangerous situation that poses an immediate risk to health, life, property, or environment and requires immediate action. Most emergencies require urgent intervention to prevent a worsening ...) for example "3E". Class 5 is usually an emergency and is therefore usually ...
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Emergency Department
An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the Acute (medicine), acute care of patients who present without prior appointment; either by their own means or by that of an ambulance. The emergency department is usually found in a hospital or other primary care center. Due to the unplanned nature of patient attendance, the department must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be Medical emergency, life-threatening and require immediate attention. In some countries, emergency departments have become important entry points for those without other means of access to medical care. The emergency departments of most hospitals operate 24 hours a day, although staffing levels may be varied in an attempt to reflect patient volume. History Accident services wer ...
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Etiology
Etiology (; alternatively spelled aetiology or ætiology) is the study of causation or origination. The word is derived from the Greek word ''()'', meaning "giving a reason for" (). More completely, etiology is the study of the causes, origins, or reasons behind the way that things are, or the way they function, or it can refer to the causes themselves. The word is commonly used in medicine (pertaining to causes of disease or illness) and in philosophy, but also in physics, biology, psychology, political science, geography, cosmology, spatial analysis and theology in reference to the causes or origins of various phenomena. In the past, when many physical phenomena were not well understood or when histories were not recorded, myths often arose to provide etiologies. Thus, an etiological myth, or origin myth, is a myth that has arisen, been told over time or written to explain the origins of various social or natural phenomena. For example, Virgil's ''Aeneid'' is a national myth ...
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Integer
An integer is the number zero (0), a positive natural number (1, 2, 3, ...), or the negation of a positive natural number (−1, −2, −3, ...). The negations or additive inverses of the positive natural numbers are referred to as negative integers. The set (mathematics), set of all integers is often denoted by the boldface or blackboard bold The set of natural numbers \mathbb is a subset of \mathbb, which in turn is a subset of the set of all rational numbers \mathbb, itself a subset of the real numbers \mathbb. Like the set of natural numbers, the set of integers \mathbb is Countable set, countably infinite. An integer may be regarded as a real number that can be written without a fraction, fractional component. For example, 21, 4, 0, and −2048 are integers, while 9.75, , 5/4, and Square root of 2, are not. The integers form the smallest Group (mathematics), group and the smallest ring (mathematics), ring containing the natural numbers. In algebraic number theory, the ...
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New York Heart Association Functional Classification
The New York Heart Association (NYHA) Functional Classification provides a simple way of classifying the extent of heart failure. It places patients in one of four categories based on how much they are limited during physical activity; the limitations/symptoms are in regard to normal breathing and varying degrees in shortness of breath and/or angina. It originated in 1928, when no measurements of cardiac function were possible, to provide a common language for physicians to communicate. Despite difficulties in applying it, such as the challenge of consistently classifying patients in class II or III, because functional capacity is such a powerful determinant of outcome, it remains arguably the most important prognostic marker in routine clinical use in heart failure today. With time the classification system evolved and updated multiple times. Presently, the ninth edition of the NYHA classification is being used in the clinical practice released in the year 1994 by the Criteria Com ...
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Glasgow Coma Scale
The Glasgow Coma Scale (GCS) is a clinical scale used to reliably measure a person's level of consciousness after a brain injury. The GCS assesses a person based on their ability to perform eye movements, speak, and move their body. These three behaviours make up the three elements of the scale: eye, verbal, and motor. A person's GCS score can range from 3 (completely unresponsive) to 15 (responsive). This score is used to guide immediate medical care after a brain injury (such as a car accident) and also to monitor hospitalised patients and track their level of consciousness. Lower GCS scores are correlated with higher risk of death. However, the GCS score alone should not be used on its own to predict the outcome for an individual person with brain injury. Scoring The Glasgow Coma Scale is used for people above the age of two and is composed of three tests: eye, verbal, and motor responses. The scores for each of these tests are indicated in the table below. The Glas ...
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White Blood Cell Count
A complete blood count (CBC), also known as a full blood count (FBC) or full haemogram (FHG), is a set of medical laboratory tests that provide cytometry, information about the cells in a person's blood. The CBC indicates the counts of white blood cells, red blood cells and platelets, the concentration of hemoglobin, and the hematocrit (the volume percentage of red blood cells). The red blood cell indices, which indicate the average size and hemoglobin content of red blood cells, are also reported, and a white blood cell differential, which counts the different types of white blood cells, may be included. The CBC is often carried out as part of a medical assessment and can be used to monitor health or diagnose diseases. The results are interpreted by comparing them to Reference ranges for blood tests, reference ranges, which vary with sex and age. Conditions like anemia and thrombocytopenia are defined by abnormal complete blood count results. The red blood cell indices can provi ...
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Hematocrit
The hematocrit () (Ht or HCT), also known by several other names, is the volume percentage (vol%) of red blood cells (RBCs) in blood, measured as part of a blood test. The measurement depends on the number and size of red blood cells. It is normally 40.7–50.3% for males and 36.1–44.3% for females. It is a part of a person's complete blood count results, along with hemoglobin concentration, white blood cell count and platelet count. Because the purpose of red blood cells is to transfer oxygen from the lungs to body tissues, a blood sample's hematocrit—the red blood cell volume percentage—can become a point of reference of its capability of delivering oxygen. Hematocrit levels that are too high or too low can indicate a blood disorder, dehydration, or other medical conditions. An abnormally low hematocrit may suggest anemia, a decrease in the total amount of red blood cells, while an abnormally high hematocrit is called polycythemia. Both are potentially life-threatening d ...
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Serum Sodium
Sodium ions () are necessary in small amounts for some types of plants, but sodium as a nutrient is more generally needed in larger amounts by animals, due to their use of it for generation of nerve impulses and for maintenance of electrolyte balance and fluid balance. In animals, sodium ions are necessary for the aforementioned functions and for heart activity and certain metabolic functions. The health effects of salt reflect what happens when the body has too much or too little sodium. Characteristic concentrations of sodium in model organisms are: 10  mM in ''E. coli'', 30 mM in budding yeast, 10 mM in mammalian cell and 100 mM in blood plasma. Additionally, sodium ions are essential to several cellular processes. They are responsible for the co-transport of glucose in the sodium glucose symport, are used to help maintain membrane polarity with the help of the sodium potassium pump, and are paired with water to thin the mucus of the airway lumen when the a ...
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Medical Scoring
There are several scoring systems in intensive care units (ICUs) today. Adult scoring systems * APACHE II was designed to provide a morbidity score for a patient. It is useful to decide what kind of treatment or medicine is given. Methods exist to derive a predicted mortality from this score, but these methods are not too well defined and rather imprecise. ** APACHE III is an updated version. * SAPS II was designed to provide a predicted mortality, that does not reflect the expected mortality for a particular patient, but is good for benchmarking. In a rather simple way, it makes it possible to provide a single number that describes the morbidity of a number of patients. * SAPS III was designed to provide a realistic predicted mortality for a particular patient or a particular group of patients. It does this by calibrating against known mortalities on an existing set of patients, for a specific definition of mortality (like 30-days mortality). This way, it can answer questions lik ...
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