MDCalc

And just going back to the protocols, the, the best protocol to use is, is UK-wide called the GIRFT guideline, or Getting It Right First Time, around HLH, and that is a beautiful, very practical manual in how to manage HLH.

So there, I would absolutely recommend if you've got somebody that you're worried about might have this, the H score can be found on the, on MDCal or other Google-related, um, uh, calculators.

And then these protocols and that support is really, really helpful, and it can be found through the UCLH, um, website.

So just to say because it's a national provision, and w- I think the minute you have one of these patients, you already feel out of your depth-

They say that all patients with type 2 diabetes or obesity, as well as overweight patients with some metabolic risk factors, should be screened with a FIB-4 index.

A FIB-4 indre- index, uh, you can get on MDCalc or wherever you get your calculators.

You basically just need the age, the platelet count, the AST and ALT, and then you can come up with the FIB-4 index.

The FIB-4 index will give you a number that will tell you whether the patient is low risk, uh, intermediate risk, or high risk.

Ideally, most labs will add the FIB-4 score to the bottom of their laboratory tests.

But if they're not doing that, then you should do it yourself.

And again, the FIB-4 test can be found on MDCalc or Google or wherever you get your calculators.

Let's move on to the next article, shall we? Which is an article that looks at CTCA, or a CT coronary angiography, after acute chest pain.

But that's ultimately what the shift was between those two scoring systems.

You can play around in apps like MDCalc.

They've got the twist score right in there.

Five questions about testicular swelling, hard testicle, absent premister, reflex, nausea, vomiting, and a high-riding testis.

And it ranges from zero to 72.

So you can use MDCalc to calculate this if you ever want to.

It's fairly easy to do on MDCalc.

You just plug in the numbers.

But then when they talk about PASI scores in psoriasis, if they say like PASI 90, PASI 75, what that means is a 75% improvement or 90% improvement in the PASI score.

there we go so we can say it's like a polarizing device certainly and then our one of our other articles too is a point and a counterpoint discussing maximum local anesthetics dose calculators so if we look through pages 884 and 888 it's a point and counterpoint and it's worth reading these together in conjunction Essentially, Nicholas Flint and his colleagues presented a web calculator for maximum local anesthetic doses.

Things like MDCalc, the calculators are said that's built for anesthesiologists and don't really take into account the types of lidocaine or anesthetic usage that we as dermatologists use.

And then the actual other counterpoint is from Jeffrey Klein, and it's pretty pointed.

He argues against this calculator, suggesting that it rests on two flawed assumptions.

So it's not even something that you need to necessarily sit there and calculate.

If not, something like MDCalc actually has it in there.

And in, you know, ten seconds, you can just put it all in and just put, "Patient has a COWS score of whatever," COWS score of ten, twelve.

They want to start buprenorphine, so I start buprenorphine.

I'd like to introduce two other screening methods that hospitals are using.

The 4AT test diagnoses delirium in older adults and is available on MDCalc.

Takes about two minutes and asks about alertness, age, date of birth, place, and year.

It assesses attention with months backwards, and lastly, change in fluctuating course.

Yeah, this is my favorite.

Just putting it to MDCalc.

Everyone should know, at least the best known one is MELD, your MELD score.

So today, transplant allocation in the United States uses the MELD 3.0, which, as most of us know, incorporates bilirubin, INR, creatinine, sodium, albumin, and gender or sex.

So giving a gram of phenobarb probably isn't that patient's true ideal body weight, and so you'd wanna make sure that you measure their height to give them a true 10 milligram per kilogram of ideal body weight.

And MDCalc is helpful for this 'cause you take their height and their weight, and it spits out a number that allows you to weight-base dose.

Then oftentimes the exact limitation of how quickly this is run over is actually based on the nursing pumps.

That's one of the biggest limitations.

So a RASS score is an alternative scoring system that's often used in the ICU to determine level of agitation for a patient or level of arousal.

And it's a score that's quite familiar in the ICU and becoming more and more common in the emergency department.

Uh, you can easily look it up on an MDCalc, and it just provides kind of a gradient of how awake versus drowsy a patient is.

Okay, great.