Assessment of Severity – Quantifying organ dysfunction

Organ Clinically Investigation
Cardiac
  • Exercise tolerance (distance walked without stopping due to pain or dyspnoea)
  • Degree of ankle/leg swelling
  • Blood pressure
  • Respiratory rate
  • Oxygen saturation
  • Gallop rhythm
  • Lung crepitations
  • Need for supplemental oxygen
  • Ability to speak comfortably
  • Mechanical – Echocardiogram, ventriculography, cardiac output monitoring (Swan-Ganz/Pulmonary artery catheter)
  • Electrical – ECG monitoring, 12 lead ECG, ellectrophysiological study
Vascular
  • Exercise tolerance (distance walked without stopping due to pain)
  • Volume and extent of peripheral pulses
  • Capillary refill
  • Skin/hair changes
  • Doppler ultrasound, arteriography
Respiratory
  • Exercise tolerance (distance walked without stopping due to dyspnoea)
  • Need for supplemental oxygen
  • Bronchodilator usage (if airways disease)
  • Respiratory rate
  • Oxygen saturation
  • Ability to speak comfortably
  • Degree of air entry
  • Gas exchange – Oxygen saturation, Arterial blood gas
  • Respiratory mechanics – Spirometry, Pressure-Volume measurment
  • Diffusion capacity – DLCO
GIT
  • Dry mucous membranes
  • BP, PR, cap refill, urine output (shock)
  • Weight loss
  • Pallor (anaemia)
  • Hair and nail strength
  • Ascites and oedema (severe protein malnutrition)
  • Motility – oesophageal motility, sphincter tone measurements
  • Digestion / Absorption – digestive enzyme assays, recovered dietary substrates
Hepato-biliary
  • Jaundice
  • Bruising
  • Ascites
  • Encephalopathy
  • Hepatic flap
  • General – bilirubin
  • Hepatocellular – AST, ALT
  • Cholestatic – ALP, GGT
  • Synthetic – albumin, globulin, INR, clotting studies
  • Metabolic – Ammonia
  • Excretory – ERCP, nuclear scan
Haematology Immunology
  • Pallor (anaemia)
  • Bruising
  • Formed elements – FBC, bone marrow biopsy
  • Clotting function – INR, APTT
  • Immunological function – WCC, IgG, complement, T & B Cells
RenalĀ 
  • Urine output
  • Glomerulo-tubular function – Urine output, creatinine
  • Synthetic – Vitamin D, Haemoglobin (i.e. erythropoetin)
  • Endocrine – hypertension
  • Renal excretion – intravenous pyelogram, CT (with IV contrast)
Urinary
  • Bladder emptying (hesitancy, flow, dribbling)
 

  • Bladder empyting – bladder ultrasound, urodynamic studies
Endocrine
  • Hormonal assays

PNS
  • Degree of sensory change
  • Degree of power loss
  • Autonomic dysfunction (postural hypotension, loss of sphincter function)
  • Nerve conduction studies
  • Electromyography
  • Sensory evoked potential
CNS
  • Consciousness
  • Orientation
  • Attention
  • Memory
  • Speech
  • EEG
  • Evoked potentials
  • PET scanning
Special senses
  • Vision – visual acuity, visual fields
  • Hearing – Tuning fork tests
  • Smell – cloves
  • Specialised visual tests
  • Audiometry
  • NB often severity can be gauged by the number of medications a person is on

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