PERHITUNGAN APACHE II SKOR

(ACUTE PHYSIOLOGICAL AND CHRONIC HEALTH EVALUATION)

Nama PX :
No. RM :
NO BED :
Tgl MICU:
Jam
:
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18

Kriteria Penilaian
Umur
Temperatur - Rectal ( C)
Mean Arterial Pressure (mmHg)
Heart Rate (ventricularresponse)
Respiratori Rate - (non ventilated or ventilated)
Oxygenation A-aDO or PaO (mmHg)
Arterial PH
Serum Sodium (mMol/L)
Serum Potasium (mMol/L)
Serum Creatinine (mg/100ML)
Hematocrit (%)
White Blood Count (x1000/mm3)
Glasgow Coma Score (GCS)
RIWAYAT PENYAKIT KRONIS (Ya/Tidak/0)
Liver Biobsi Proven Cirrhosis and Documented Portal Hypertention or Prior
Episodes of Hepatic Failure
Cardiovasculer NYHA Class IV
Respiratory Age Severe COPD, Hipercapnia, Home O, Pulmunary
Hypertention
Renal Chronic Dialysis
Immunocompromised (Leukemia, DM, AIDS, Chemotherapy, Lupus, RA,
Lymphoma, etc)
Total APACHE SCORE
% Angka Kematian

Keterangan:
Ya
Tidak
0
Interpretasi Skor
0-4 =
5-9 =
10-14 =

: Mempunyai riwayat penyakit kronis dan post operasi elektif

: Mempunyai riwayat penyakit kronis dan tidak operasi atau
Mempunyai riwayat penyakit kronis dan operasi emergensi
: Tidak mempunyai riwayat penyakit kronis

4 % angka kematian
8 % angka kematian
15 % angka kematian

15-19 =

25 % angka kematian

VALUATION)

Nilai
25
41
65
120
30
70
7.23
125
3
5
34
16
8

Skor
0
4
2
2
1
0
3
2
1
4
0
1
7

ya

tidak

ya

2
36
85

20-24 = 40% angka kematian

25-29 = 55% angka kematian
30-34 = 75% angka kematian

> 34

85% angka kematian

SISTIM SKORING APACHE

Nomer Register:

Nama Pasien:
A. Acute Physiologi Score
Physiologic Variable

+4

High Abnormal Range

+3
+2

Temperatur - Rectal ( C)

41

39 - 40,9

Meal Arterial Pressure - mmHg

160

130 -159

110 - 129

180

140 - 179

110 - 139

Respiratori Rate - (non ventilated or ventilated)

Oxygenation A-aDO or PaO (mmHg)
a. FIO 0,5 record A-aDO
b. FIO < 0,5 record only PaO

50

39 - 49

500

350 - 499

200 -349

Arterial PH

> 7,7

7,6 - 7,69

Serum Sodium (mMol/L)

180

160 -179

155 -159

6 - 6.9

3,5

2 - 3,4

1,5 - 1,9

60
40

50 - 59,9
20 - 39,9

Heart Rate (ventricularresponse)

Serum Potasium (mMol/L)

Serum Creatinine (mg/100ML)
(double point for ARF)

Hematocrit (%)
White Blood Count (x1000/mm3)
Glasgow Coma Score (GCS)
Score = 15 minus actual GCS

A. Total Acute Physiologic Score (APS)

Sum of the 12 individual variable point

B. Age Points
Age
Point
(year)

44

45 - 54

55 - 64

C. Chronicc Health Point

History
Liver Biobsi Proven Cirrhosis and Documente
Hypertention or Prior Episodes of Hepatic Fa
Cardiovasculer NYHA Class IV
Respiratory Age Severe COPD, Hipercapnia,
Pulmunary Hypertention

65 - 74

Renal Chronic Dialysis

75

Immunocompromised

0 to 4 = ~4% death rate 10 to 14 = ~15% death rate 20 to 24 = ~40% death rate 30 to 34 = ~75% death rate
5 to 9 = ~8% death rate 15 to 19 = ~25% death rate 25 to 29 = ~55% death rate Over 34 = ~85% death rate

TIM SKORING APACHE II

Nomer Register:

Tanggal Masuk ICU:

mal Range

Low Abnormal Range

+2
+3

+1

+1

38,5 - 38,9

36 - 38,4

34 - 35,9

32 - 33,9

30 - 31,9

29,9

70 - 109

50 -69

49

70 - 109

55 - 69

40 - 54

39

25 - 34

12 - 24

10 - 11

6-9

PO 55 60

PO < 55

< 200
PO 61 70
PO> 70

+4

7,5 - 7,59

7,33 -7,49

7,25 -7,32 7,15 -7,24

< 7,15

150 - 154

130 -149

120 - 129

111 - 119

110

5,5 - 5,9

3,5 - 5,4

3 - 3,4

2,5 - 2,9

< 2,5

0,6 - 1,4

< 0,6

46 - 49,9
15 - 19,9

30 - 45,9
3 - 14,9

20 - 29,9
1 - 2,9

< 20
<1

Nilai
Pasien

Score

Total APACHE Score

Point for
Elective Surgery

Point for Emergency Surgery

and none operative patients

A : APS Score

B : Age Point

C. Chronic Point Score

Total APACE II SCORE

2
2

5
5

Total APACE II SCORE

Score