| 1. |
Age in Years |
|
| 2. |
History of severe organ insufficiency or
immunocompromised? |
|
| 3. |
Rectal Temperature (Celsius) |
|
| 4. |
Mean arterial pressure (mmHg) |
|
| 5. |
Heart rate (ventricular response) |
|
| 6. |
Respiratory Rate (non-ventilated or ventilated)
|
|
| 7. |
Oxygenation (use PaO2 if FiO2 < 50%, otherwise use A-a
gradient) |
|
| 8. |
Arterial pH |
|
| 9. |
Serum sodium (mMol/L) |
|
| 10. |
Serum potassium (mMol/L) |
|
| 11. |
Serum Creatinine (mg/100 mL) |
|
| 12. |
Hematocrit (%) |
|
| 13. |
White blood count (total/cubic mm in 1000's) |
|