Wednesday, February 29, 2012

Alvarado Appendicitis Score

Alvarado score
UseEvaluate likelihood of appendicitis in adult
ScoringScore: 0 for no
- Migration of pain to right lower quadrant  (1 for yes)
- Anorexia or acetone in urine  (1 for yes)
- Nausea-vomiting  (1 for yes)
- Right lower quadrant tenderness  (2 for yes)
- Rebound pain  (1 for yes)
- Fever  (1 for yes)
- WBC > 10K  (2 for yes)
- Left shift (over 75% neutrophils)  (1 for yes)
Assessment<5:  appendicitis less likely
 5-6: possible appendicitis
7-8: probably appendicitis
>8: very probably appendicitis

Peripheral vs Central Vertigo

Distinguishing Characteristics of Peripheral vs. Central Causes of Vertigo

FeaturePeripheral VertigoCentral Vertigo
Nystagmus   Combined horizontal and torsional
No directional change with gaze
Inhibited by eye fixation
Fade after a few days
Purely unidirectional
Directional change with gaze towards fast phase
Not inhibited by eye fixation
May last weeks to months
Imbalance Mild to moderate
Able to walk
Severe imbalance
Unable to stand still or walk
Nausea, vomiting May be severeVaries
Hearing loss, tinnitusCommonRare
Non-auditory symptomsRareCommon
Latency following
provocative test
Long (up to 20 seconds)Short (up to 5 seconds)

Reference:  Initial Evaluation of Vertigo, Jan 15, 2006 American Family Physician

Tuesday, February 28, 2012

Shock Index

Shock Index
UseEvaluate possibility of acute critical illness
Calculationheart rate/systolic blood pressure
Normal0.5 - 0.7
Significancelow sensitivity
> 0.9: associated with higher risk of morbidity, mortality and admission