CAUTI Criteria
Urine culture sets window period. Identify first element to meet CAUTI. If a Foley is removed and inserted, there should be a one day gap to not be considered continuous
Urine Management System
Tag: criteria
CMS Severe Sepsis/Septic Shock Quick Reference
(Updated for July 2022 specifications)
Date and time of all interventions must be clearly documented
*3 hours calculated from initial hypotension
**3 hours calculated from initial hypotension or septic shock, whichever is first
Crystalloid Fluid Administration
A physician/APN/PA order for less than 30 mL/kg of crystalloid fluids is acceptable for the target ordered volume if all of the following criteria were met:
• There is a physician/APN/PA order for the lesser volume of crystalloid fluids as either a specific volume (e.g., 1500 mL) or a weight-based volume (e.g., 25 mL/kg).
• The ordering physician/APN/PA documented within a single note in the medical record all the following:
o The volume of fluids to be administered as either a specific volume (e.g., 1500 mL) or a weight-based volume (e.g., 25 mL/kg) AND
o a reason for ordering a volume less than 30 mL/kg of crystalloid fluids
REFERENCE:
For patients with COVID-19, we are using drugs that prolong QT-interval. The risk of life-threatening arrhythmias from QT prolongation may be higher. This article reports a scoring system to identify patients that are at risk for QT prolongation.
The study found that the following factors predicted QTc prolongation: female, sepsi, LV dysfunction, administration of QT-prolong drug, >= 2 QT prolonging drugs, loop-diuretic, age >68, serum K <3.5, admitting ATc >450ms.
A risk score was developed. Risk was classified as low (score of 0-6), moderate (7-10) and high (11-21).
A high risk score >11 was associated with 74% Sn and 77% Sp (PPV 79% NPV 76) for predicting QTc prolongation. Incidence of QTc prolongation 15% in low risk, 37% in moderate risk and 73% in high risk.
Reference:
Tisdale, J., Jaynes, H., Kingery, J., Mourad, N., Trujillo, T., Overholser, B., & Kovacs, R. (2013). Development and Validation of a Risk Score to Predict QT Interval Prolongation in Hospitalized Patients. Circulation: Cardiovascular Quality And Outcomes, 6(4), 479-487. doi: 10.1161/circoutcomes.113.000152
There are two criteria used to screen patients with blunt trauma of cerebrovascular injury: the Denver and Memphis criteria
Denver Criteria
1. LeForte II or III fracture pattern
2. Cervical spine fracture or subluxation
3. Basilar skull fracture with involvement of the carotid canal
4. DAI with GCS <6
5. Near hanging with anoxic brain injury
Memphis Criteria:
1. Cervical spine fracture
2. LeForte II or III facial fracture
3. Basilar skull fracture with involvement of the carotid canal
4. Horner’s syndrome
5. Neurologic deficit not explained by imaging studies
6. Neck soft-tissue injury (seatbelt sign, hematoma, or hanging)
Weaning parameter values typically used to predict weaning outcome
Hemodynamic and respiratory parameters used to determine readiness for spontaneous breathing trial
Hemodynamic and respiratory parameters used to determine an unsuccessful spontaneous breathing trial
Hemodynamic and respiratory parameters used to determine readiness for spontaneous breathing trial in neurosurgical patients
Reference:
Layon, A. Joseph, Andrea Gabrielli, and William Friedman. Textbook Of Neurointensive Care. London: Springer London, 2013. Print.
N.E.X.U.S. = National Emergency X-ray Utilization Study
Utility: if criteria fulfilled, low risk for spinal injury and c-spine can be cleared without the need for imaging
NEXUS Criteria:
- Normal level of alertness
- Not intoxicated
- No midline cervical spine tenderness
- No other painful injuries that may distract the patient from a less painful (but broken) neck
- No focal neurologic deficits
Only if patient fulfills all 5 criteria – then forego imaging. Otherwise, proceed with imaging.
Mnemonic: NSAID (neuro deficit, spinal tenderness, AMS, intoxication, distracting injury)
Reference:
Hoffman, Jerome R et al. “Selective Cervical Spine Radiography In Blunt Trauma: Methodology Of The National Emergency X-Radiography Utilization Study (NEXUS)”. Annals of Emergency Medicine 32.4 (1998): 461-469. Web.
References
Adams, H. P. et al. “Classification Of Subtype Of Acute Ischemic Stroke. Definitions For Use In A Multicenter Clinical Trial. TOAST. Trial Of Org 10172 In Acute Stroke Treatment”. Stroke 24.1 (1993): 35-41. Web.
The table below shows the RIFLE (Risk Injury Failure Loss End stage) classification scheme for acute kidney injury.
This system has a separate criteria for creatinine and urine output. If the patient’s condition falls under two different levels, then the worse classification should be used.
RIFLE-FC = denotes ‘acute-on-chronic’ disease.
RIFLE-FO = when RIFLE-F classification is reached by urine output criteria only
Checklist: AKI work-up
- Urinary sediment
- Urinalysis
- exclude obstruction
- review of meds
- rhabdomyolysis: creatine kinas, free myoglobin
- vasculitis: CXR, blood smear, measurement of nonspecific inflammatory markers, specific antibodies (anti-GBM, ANCA, anti-DNA, anti-smooth muscle)
- TTP: LDH, haptoglobin, unconjugated bilirubin, free hemoglobin
- Cryoglobulins
- Bence-Jones proteins
- Renal biopsy
References
Bersten, Andrew D, and Neil Soni. Oh’s Intensive Care Manual. London: Elsevier Health Sciences UK, 2013. Print.
Diagnostic Criteria (1 of 3 for exudative)
PF protein / serum protein >0.5
PF LDH / serum LDH >0.6
PF LDH >2/3 upper limit of normal LDH
Disseminated Intravascular Coagulation Scoring System
TREATMENT:
- no specific treatment other than that directed against predisposing condition
- bleeding – replace platelets and coagulation factors
- cryoprecipitate 10 units = fibrinogen 2.5 g –> but this rarely helps, consumption of platelets and coagulation proteins can aggravate thrombosis
- heparin is ineffective in retarding microvascular thrombosis (due to depletion of antithrombin III)
- give heparin with AT-III? – 90-120 units load then 90-120 units daily x 4 days (no evidence for improvement in mortality)
References:
Marino, Paul L, and Kenneth M Sutin. The ICU Book. Philadelphia: Lippincott Williams & Wilkins, 2007. Print.
Kiwon Lee. NeuroICU Book
Peripheral Brain 