Terminology

From COVID-19 CY National eHealth Platform of the Ministry of Health for Inpatient and Home-monitoring and Treatment
Revision as of 02:32, 24 April 2020 by Covid19admin (talk | contribs) (Modified Early Waring System (MEWS) Score)
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In this page all the terms used to describe the health in the Patient Profile screen are presented. Below each term in Ranges and Scores sections you can find links to the locations of the Patient Profile wiki page where the corresponding terms are used. By clicking these links you will be driven to the corresponding parameter's section in the Patient Profile page of this wiki.

Acronyms Finder

Vital Signs Arterial Blood Gases Laboratory Information System Social history
Temperature (°C)
Heart Rate (bpm)
Systolic Pressure (mm Hg)
Diastolic Pressure (mm Hg)
Respiratory Rate (bpm)
SpO2 (%)
Urine Output (ml/kg/h)
pH
HCO3 (mEq/L)
PaCO2 (mmHg)
PaO2 (mmHg)
SaO2 (%)
FiO2 (%)
PaO2/FiO2
SpO2/FiO2
Covid-19 Related
hs-CRP ((mg/L))
IL-6 (pg/L)
ESR (mm/h)
Serum ferritin (ng/mL)
PT (s)
APTT (s)
D-dimer (μg/mL)
Covid-19 Test Type
Nasopharyngeal
Oropharyngeal
Bronchoalveolar Lavage
Alcohol intake
Health-related behavior
Tobacco use and exposure
Exercise
Details of drug misuse behavior
Nutritional observable
Employment detail
Toxic exposure status


Comorbidities Symptoms Symptoms (cont.) Ventilation Treatment
Hypertension
Diabetes
Cardiovascular disease
Liver disease
Nervous system disease
Chronic respiratory/ lung disease
Chronic kidney disease
Endocrine system disease
Hematologic disease
Tumor
Immunosuppression
Immunodeficiency
Constitutional
Fever
Myalgia
Headache
Upper Respiratory
Rhinorrhea
Nasal Congestion
Sore throat
Lower Respiratory
Dyspnea
Chest tightness
Cough
Sputum
Gastrointestinal
Nausea
Diarrhea
Neurological
Ageusia
Anosmia
Communication disorder
Acquired Confusion
Lethargy
Non Ventilated (oxygen therapy)
Nasal Cannula
Venturi Mask
Non Re-breathing Mask
Non Invasive Ventilation
Noninvasive Positive Pressure Ventilation (NIPPV)
Continuous Positive Airway Pressure (CPAP)
High Flow Nasal Cannula (HFNC)
Inv asive Ventilation
Intermittent Mandatory Ventilation (IMV)
IMV with ECMO

Ranges

Vital Signs

Definition

Vital Signs
Type Ranges
Temperature (°C) 36.1 -37.2 (°C)
Heart Rate (bpm) 60-100 (bpm)
Systolic Pressure (mm Hg) 90-140 (mm Hg)
Diastolic Pressure (mm Hg) 75-90 (mm Hg)
Respiratory Rate (bpm) 16-20 (bpm)
SpO2 (%) >93%
Urine Output (ml/kg/h) Based on Fluid Balance (Intake/ Output)
Find it in Patient Profile wiki page: [Demographics & Status], [Monitoring Charts], [Daily Monitoring]

Arterial Blood Gases (ABG)

Definition

An arterial blood gases (ABG) test measures the acidity (pH) and the levels of oxygen and carbon dioxide in the blood from an artery. This test is used to check how well your lungs are able to move oxygen into the blood and remove carbon dioxide from the blood.

Arterial Blood Gases
Type Ranges
pH 7.35 - 7.45
HCO3 (mEq/L) 22 - 26 (mEq/L)
PaCO2(mmHg) 35 - 45 (mmHg)
PaO2 (mmHg) 75 - 100 (mmHg)
SaO2 (%) 95% - 100%
Find it in Patient Profile wiki page: [Demographics & Status], [Monitoring Charts], [Daily Monitoring]

Laboratory Information System (LIS)

Definition

Laboratory Information System
Process Type Ranges
Infection-related Indices hs-CRP (mg/L) 0-5 (mg/L)
IL-6 (pg/L) 0-7 (pg/L)
ESR (mm/h) 0-15 (mm/h)
Serum ferritin (ng/mL) 21.8-274.66 (ng/mL)
Coagulation Function PT (s) 10.5-13.5 (s)
APTT (s) 21-37 (s)
D-dimer (μg/mL) 0-1.5 (μg/mL)

Process Type Ranges
Hematologic White blood cells (x109/mL) 3.5-9.5 (x109/mL)
Neutrophils (x109/mL) 1.8-6.3 (x109/mL)
Lymphocytes (x109/mL) 1.1-3.2 (x109/mL)
Monocytes (x109/mL) 0.1-0.6 (x109/mL)
Platelets (x109/mL) 125-350 (x109/mL)
CD3 (/μL) NA
CD4 (/μL) NA
CD8 (/μL) NA
Biochemical Total bilirubin (mg/dL) 0-26 (mg/dL)
AST (U/L) 15-40 (U/L)
ALT (U/L) 9-50 (U/L)
Total protein (g/L) 65-85 (g/L)
Albumin (g/L) 40-55 (g/L)
Globulin (g/L) 20-40 (g/L)
Prealbumin (mg/L) 200-430 (mg/L)
Urea (mM) 3.6-9.5 (mM)
Creatinine (μM) 57-111 (μM)
Glucose (mM) 3.9-6.1 (mM)
CK-MB (U/L) 0-24 (U/L)
Cholinesterase (U/L) 5000-12000 (U/L)
Cystatin C (mg/L) 0.6-1.55 (mg/L)
LDH (U/L) 120-150 (U/L)
α-HBDH (U/L) 72-182 (U/L)
LDL (mM) 2.1-3.37 (mM)
Find it in Patient Profile wiki page: [Daily Monitoring], [Laboratory]

Disease Severity Indicators

Acute Respiratory Distress Syndrome (ARDS) Severity

Definition

The Acute Respiratory Distress Syndrom (ARDS) severity levels are calculated using the Berlin Definition as follows:

  • ARDS
- Mild ARDS: 200mmHg < PaO2/FiO2 ≤ 300 mmHg && (PEEP or CPAP ≥ 5 cmH2O) or non-ventilated.
- Moderate ARDS: 100mmHg < PaO2/FiO2 ≤ 200 mmHg && PEEP ≥ 5 cmH2O or non-ventilated.
- Severe ARDS: PaO2/FiO2 ≤ 100 mmHg && PEEP ≥ 5 cmH2O or non-ventilated.
  • ARDS when PaO2 not available.
- SpO2/FiO2 ≤ 315 suggests ARDS (including non-ventilated patients)
Berlin Definition of ARDS
ARDS Severity PaO2/FiO2
Mild >200-300
Moderate >100 - 200
Severe ≤100
*on positive end expiratory pressure (PEEP) ≥ 5 cm H2O
Find it in Patient Profile wiki page: [Demographics & Status]

Modified Early Waring System (MEWS) Score

Definition

To calculate the Modified Early Warning System (Mews) score, we rank each one of values of the entries listed in the first column of Table Mews Calculation, based on where they fall in pre-defined ranges and then we sum-up all the ranks.

MEWS Score Range Frequency of monitoring Clinical Response
0-4 Minimum 12 hours Continue to monitor and review MEWS every 12 hours
5-6 Minimum 4 hours Consider notifying physician of MEWS score Notify charge nurse

Consider placing a consult to Rapid Response Nurses

Increase MEWS assessment every 4 hours with increased frequency in assessments

7+ Maximum per 2 hours Consider calling Physician with current assessment data

Consider calling a Rapid Response Call RRT Consult nurse Consider transferring to step-down or ICU


Modified Early Warning System (MEWS)
Feature Value Range Score
Respiratory Rate (bpm) ≤8 2
9 - 14 0
15 - 20 1
21 - 29 2
>29 3
Heart Rate (bpm) ≤ 40 2
41 - 50 1
51 - 100 0
101 - 110 1
111 - 129 2
> 129 3
Systolic BP (mmHg) ≤ 70 3
71 - 80 2
81 - 100 1
101 - 199 0
≥ 200 2
Urine Output (ml/kg/h) Nil 3
< 0.5 2
Temperature (ºC) ≤ 35 2
35.1 - 36 1
36.1 - 38 0
38.1 - 38.5 1
≥ 38.6 2
Total:
Important Assumptions:  
1. When Urine Output is not inserted (i.e., NULL value), then the MEWS score is still computed assigning zero (0) points to Urine Output.
2. To compute the Urine Output per hour we calculate the time difference between the present Urine Output entry and the last non-NULL entry.
Find it in Patient Profile wiki page: [Demographics & Status], [Daily Monitoring]

Glasgow Coma Scale Score

Definition

To calculate the Glasgow Coma Scale score, we rank each one of values of the entries listed in the first column of Table Gasgow Calculation, based on where they fall in pre-defined ranges and then we sum-up all the ranks.

Glasgow Coma Scale
Behavior Response Score
Eye opening Spontaneous 4
To speech 3
To pain 2
None 1
Verbal response Oriented 5
Confused 4
Words (Inappropriate) 3
Sounds (Incomprehensible) 2
None 1
Motor response Obeys commands 6
Localizes to pain 5
Withdraws from pain 4
Flexion to pain (decorticate) 3
Extension to pain (decerebrate) 2
None 1
Assessment /15
Total Score Mild 13-15
Moderate 9-12
Severe 8 or less
Find it in Patient Profile wiki page: [Patient Profile-> Demographics & Status], [Patient Profile -> Demographics & Status -> Add Assessment], [Patient Profile -> Daily Monitoring]

Find it in Patient Profile wiki page: [Patient Profile-> Demographics & Status], [Patient Profile -> Demographics & Status -> Add Assessment], [Patient Profile -> Daily Monitoring]

Hscore

Definition

The Hscore generates a probability for the presence of secondary haemophagocytic lymphohistiocytosis (HLH)1.

  • Hscores greater that 169 are 93% sensitive and 86% specific for HLH.

Note that bone marrow haemophagocytosis is not mandatory for a diagnosis of HLH.2

Hscore
Temperature
<38.4 0
38.4-39.4 33
>39.4 49
Organomegaly
None 0
Hepatomegaly or splenomegaly 23
Hepatomegaly and splenomegaly 38
Number of cytopenias
One lineage 0
Two lineages 24
Three lineages 34
Triglycerides (mmoL/L)
<1.5 mmol/L 0
1.5-4.0 mmol/L 44
>4 mmol/L 64
Fibrinogen (g/L)
>2.5 g/L 0
<=2.5 g/L 30
Ferritin ng/ml
<2000 ng/ml 0
2000-6000 ng/ml 35
>6000 ng/ml 50
Serum aspartate aminotransferase
<30 IU/L 0
>=30 IU/L 19
Haemophagocytosis on bone marrow aspirate
No 0
Yes 35
Known immunosuppression
No 0
Yes 18
Hscore

1Fardet, L., Galicier, L., Lambotte, O., Marzac, C., Aumont, C., Chahwan, D., Coppo, P. and Hejblum, G., 2014. Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome. Arthritis & Rheumatology, 66(9), pp.2613-2620.
2Mehta, P., McAuley, D.F., Brown, M., Sanchez, E., Tattersall, R.S. and Manson, J.J., 2020. COVID-19: consider cytokine storm syndromes and immunosuppression. The Lancet.

Ventricular Arrhythmia Risk

Ventricular Arrhythmia Risk Due to Hydroxychloroquine-Azithromycin Treatment For COVID-191

Risk Score For Drug-Associated QTc Prolongation2
Risk Factors Points
Age ≥ 68 years 1
Female Sex 1
Loop diuretic 1
Serum K+ ≤3.5 mEq/L 2
Admission QTc ≥ 450 ms 2
Acute MI 2
≥2 QTc-prolonging drugs 3
Sepsis 3
Heart failure 3
One QTc-prolonging drug 3
Maximum Risk Score 21
Low Risk ≤6 points
Moderate Risk 7-10 points
High Risk ≥11 points
K+ indicates potassium; and MI, myocardial infarction.

1Timothy F. Simpson, Richard J. Kovacs, and Eric C. Stecker, Ventricular Arrhythmia Risk Due to Hydroxychloroquine-Azithromycin Treatment For COVID-19, Cardiology Magazine, Mar. 29, 2020

2 Tisdale JE, Jayes HA, Kingery JR, et al. Development and validation of a risk score to predict QT interval prolongation in hospitalized patients. Circ Cardiovasc Qual Outcomes. 2013;6:479-487.