MDCalc » Surgery

King’s College Criteria

admin — Thu, 18 Mar 2010 11:53:44 +0000

Fulminant hepatic failure secondary to acetaminophen poisoning: a systematic review and meta-analysis of prognostic criteria determining the need for liver transplantation. Crit Care Med. 2003 Jan;31(1):299-305.
Goldfrank's Toxicologic Emergencies, 8th Edition.
Treatment of hepatic encephalopathy. N Engl J Med. 1997 Aug 14;337(7):473-9.

Grade 1 - Inverted sleep pattern; forgetfulness, mild confusion, agitation, irritability, tremor, apraxia
Grade 2 - Lethargy, slow responses; Disorientation for time or place, Subtle personality change; Asterixis, dysarthria, ataxia
Grade 3 - Somnolence but rousability, Disorientation as regards place; Asterixis, hyperactive reflexes, Babinski signs, muscle rigidity
Grade 4 - Coma (unresponsive to verbal or noxious stimuli)

Mangled Extremity Severity Score (MESS Score)

admin — Thu, 18 Mar 2010 04:03:14 +0000

Source: Objective criteria accurately predict amputation following lower extremity trauma. Johansen, K. Journal of Trauma, 1990.

Hunt and Hess Classification of Subarachnoid Hemorrhage (SAH)

admin — Mon, 02 Mar 2009 18:47:36 +0000

Intracerebral Hemorrhage (ICH) Score

admin — Mon, 02 Mar 2009 18:46:49 +0000

Child-Pugh Score for Cirrhosis Mortality

admin — Wed, 11 Feb 2009 14:15:18 +0000

Child CG, Turcotte JG. Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64.
Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R (1973). Transection of the oesophagus for bleeding oesophageal varices. The British journal of surgery 60 (8).

PELD Score (Pediatric End-Stage Liver Disease) (younger than 12)

admin — Fri, 02 Jan 2009 04:24:49 +0000

PELD Score = 10* (0.480 * ln(bilirubin) + 1.857 * ln(INR) - 0.687 * ln(albumin) + 0.436 (if pt < 1 year: scores for patients listed for liver transplantation before the patient's first birthday continue to include the value assigned for age (< 1 Year) until the patient reaches the age of 24 months) + 0.667 (if pt has growth failure of <-2 Standard deviation) )

UNOS PELD Calculator

Parkland Formula for Burns

admin — Fri, 02 Jan 2009 04:23:16 +0000

Fluid Requirements = TBSA burned(%) x Wt (kg) x 4mL
Give 1/2 of total requirements in 1st 8 hours, then give 2nd half over next 16 hours.

MELD Score (Model For End-Stage Liver Disease) (12 and older)

admin — Fri, 02 Jan 2009 04:20:46 +0000

MELD Score = (0.957 * ln(Serum Cr) + 0.378 * ln(Serum Bilirubin) + 1.120 * ln(INR) + 0.643 ) * 10 (if hemodialysis, value for Creatinine is automatically set to 4.0)

UNOS MELD Calculator

Lactate > 3.5 mg/dL (0.39 mmol/L) 4 hrs after early fluid resuscitation?	Yes
pH < 7.30 or lactate > 3 mg/dL (0.33 mmol/L) after full fluid resuscitation at 12 hours	Yes
INR > 6.5 (PTT > 100s)	Yes
Creatinine > 3.4 mg/dL (300 µmol/L)	Yes
Grade 3 or 4 Hepatic Encephalopathy?	Yes
Phosphorus > 3.75 mg/dL (1.2 mmol/L) at 48 hours	Yes

Limb Ischemia for >6 Hours?	Yes Limb Ischemia Points x2
Limb Ischemia	Reduced Pulse but Normal Perfusion +1 Pulseless, Paresthesias, Slow Capillary Refill +2 Cool, Paralysis, Numb/Insensate +3
Patient Age Range	>30 years old 0 30-50 years old +1 50 years old +2
Shock	SBP > 90 Consistently 0 Hypotension Transiently +1 Persistent Hypotension+2
Injury Mechanism	Low Energy (stab, gunshot, simple fracture) +1 Medium Energy (dislocation, open/multiple fractures) +2 High Energy (high speed MVA or rifle shot) +3 Very High Energy (high speed trauma with gross contamination) +4
MESS Score	points
A score >7 predicts a low likelihood of limb/extremity viability.

Glasgow Coma Scale (GCS)	3-4 +2 5-12 +1 13-15 +0
Age ≥ 80?	Yes +1
ICH Volume ≥ 30ml?	Yes +1
Intraventricular Hemorrhage?	Yes +1
Infratentorial Origin of Hemorrhage?	Yes +1
Score	points

Total Bilirubin	<2 mg/dL (<34 µmol/L) +1 2-3 mg/dL (34-50 µmol/L) +2 >3 mg/dL (>50 µmol/L) +3
Albumin	>3.5 g/dL (>35 g/L) +1 2.8-3.5 g/dL (28-35 g/L) +2 <2.8 g/dL (<28 g/L) +3
INR	<1.7 +1 1.7-2.2 +2 >2.2 +3
Ascites	No Ascites +1 Ascites, Medically Controlled +2 Ascites, Poorly Controlled +3
Encephalopathy	No Encephalopathy +1 Encephalopathy, Medically Controlled +2 Encephalopathy, Poorly Controlled +3
Score	points

Age	years old
Serum Bilirubin	mg/dL
Albumin	g/dL
INR
Does the patient have growth failure (see page 3 of linked PDF)?	Yes
PELD Score

Signs/Symptoms:
Mild Headache, Alert and Oriented, Minimal (if any) Nuchal Rigidity Full Nuchal Rigidity, Moderate-Severe Headache, Alert and Oriented, No Neuro Deficit (Besides CN Palsy) Lethary or Confusion, Mild Focal Neurological Deficits Stuperous, More Several Focal Deficit Comatose, showing signs of severe neurological impairment (ex: posturing)
Grade

Patient Weight	lbs
Estimated Percentage Body Burned	%
Fluid Requirements, 1st 24 Hours	Liters
Fluid Requirements, First 8 Hours (1/2 of total)	Liters
Rule of 9's for Adults: 9% for each arm, 18% for each leg, 9% for head,18% for front torso, 18% for back torso. Rule of 9's for Children: 9% for each arm, 14% for each leg, 18% for head, 18% for front torso, 18% for back torso.

Serum Bilirubin	mg/dL
INR
Serum Creatinine	mg/dL
Has the patient had dialysis at least twice in the past week?	Yes
MELD Score	points