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Evaluation

Glasgow Coma Score, lowest value (enter from 3 to 15)

Heart rate, most abnormal (low or high)

beats/minute

Systolic blood pressure, most abnormal (low or high)

mm Hg

Serum urea nitrogen, highest value

Serum creatinine highest value

Urinary output per day (if on dialysis, use predialysis value)

liters

White blood cell count most abnormal (low or high)

Platelet count most abnormal (low or high)

Bilirubin highest value

Prothrombin time, highest value

seconds

PT, upper limit of reference range

seconds

Is the patient receiving mechanical ventilation or CPAP?

PaO2

mm Hg

FIO2 (enter as a decimal from 0.2 to 1.0)

Results

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