急診臨床計算機 — 中毒／精神

Brief Alcohol Withdrawal Scale (BAWS)
BAWS 簡式酒精戒斷量表

領域：中毒｜來源數：1

Tremor

No tremor0Not visible, but can be felt1Moderate, with arms extended2At rest, without arms extended3

Diaphoresis/sweats

No sweats0Mild, barely visible1Beads of sweat2Drenching sweats3

Agitation

Alert and calm (RASS = 0)0Restless, anxious, apprehensive, movements not aggressive (RASS = 1)1Agitated, frequent non-purposeful movement (RASS = 2)2Very agitated or combative, violent (RASS = 3 or 4)3

Confusion/orientation

Oriented to person, place, time0Disoriented to time or place, but not both1Disoriented to time and place2Disoriented to person3

Hallucinations

None｜無0Mild (vague report, reality testing intact)1Moderate (more defined hallucinations)2Severe (obviously responding to internal stimuli, poor reality testing)3

來源：MDCalc；Rastegar DA, Applewhite D, Alvanzo AAH, Welsh C, Niessen T, Chen ES. Development and implementation of an alcohol withdrawal protocol using a 5-item scale, the Brief Alcohol Withdrawal Scale (Baws). Subst Abus. 2017;38(4):394-400.
MDCalc：https://www.mdcalc.com/calc/10446/brief-alcohol-withdrawal-scale-baws

CIWA-Ar for Alcohol Withdrawal
CIWA-Ar 酒精戒斷評估

領域：中毒｜來源數：1

Nausea/vomiting

No nausea and no vomiting0Mild nausea and no vomiting1(More severe symptoms)2(More severe symptoms)3Intermittent nausea with dry heaves4(More severe symptoms)5(More severe symptoms)6Constant nausea, frequent dry heaves and vomiting7

Anxiety

No anxiety, at ease0Mildly anxious1(More severe symptoms)2(More severe symptoms)3Moderately anxious, or guarded, so anxiety is inferred4(More severe symptoms)5(More severe symptoms)6Equivalent to acute panic states as seen in severe delirium or acute schizophrenic reactions7

Agitation

Normal activity0Somewhat more activity than normal activity1(More severe symptoms)2(More severe symptoms)3Moderately fidgety and restless4(More severe symptoms)5(More severe symptoms)6Paces back and forth during most of the interview, or constantly thrashes about7

Tactile disturbances

None｜無0Very mild itching, pin and needles, burning, or numbness1Mild itching, pin and needles, burning, or numbness2Moderate itching, pin and needles, burning, or numbness3Moderately severe hallucinations4Severe hallucinations5Extremely severe hallucinations6Continuous hallucinations7

Auditory disturbances

Not present0Very mild harshness or ability to frighten1Mild harshness or ability to frighten2Moderate harshness or ability to frighten3Moderately severe hallucinations4Severe hallucinations5Extremely severe hallucinations6Continuous hallucinations7

Orientation/clouding of sensorium

Oriented, can do serial additions0Can't do serial additions or is uncertain about date1Disoriented for date by no more than 2 calendar days2Disoriented for date by more than 2 calendar days3Disoriented to place or person4

來源：MDCalc；Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. 1989 Nov;84(11):1353-7. PubMed PMID: 2597811.
MDCalc：https://www.mdcalc.com/calc/1736/ciwa-ar-alcohol-withdrawal

Columbia Suicide Severity Rating Scale (C-SSRS)
C-SSRS 哥倫比亞自殺嚴重度量表

領域：精神｜來源數：1

If the answer to question 2 is YES, proceed to questions 3-6; if the answer to question 2 is NO, skip to question 6.

來源：MDCalc；Posner K, Brown GK, Stanley B, et al. The Columbia–Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011;168:1266–1277.
MDCalc：https://www.mdcalc.com/calc/10169/columbia-suicide-severity-rating-scale-c-ssrs

HEADS-ED
HEADS-ED 兒少心理社會篩檢

領域：精神｜來源數：1

Home

Supportive0Conflicts1Chaotic/dysfunctional2

Education, employment

On track0Grades dropping or absenteeism1Failing/not attending2

Activities & peers

No change0Reduction in activities/increased peer conflicts1Increasingly to fully withdrawn/significant peer conflicts2

Drugs & alcohol

None or infrequent0Occasional1Frequent/daily2

Suicidality

No thoughts0Ideation1Plan or gesture2

Emotions, behaviors, thought disturbance

Mildly anxious/sad/acting out0Moderately anxious/sad/acting out1Significantly distressed/unable to function/out of control/bizarre thoughts/significant change in functioning2

Discharge or current resources

Ongoing/well connected0Some/not meeting needs1None/on waitlist/noncompliant2

來源：MDCalc；Cappelli M, Gray C, Zemek R, et al. The HEADS-ED: a rapid mental health screening tool for pediatric patients in the emergency department. Pediatrics. 2012;130(2):e321-327.
MDCalc：https://www.mdcalc.com/calc/10463/heads-ed

Acetaminophen Overdose and NAC Dosing
Acetaminophen 過量 NAC 劑量

領域：中毒｜來源數：2

高醫 Encore 300mg/3ml/amp Standard acetylcysteine infusion 第一袋: 200mg/kg in D5W or N/S 500ml IVD over 4 hours 第二袋: 100mg/kg in D5W or N/S 1000ml IVD over 16 hours 速算支數:第一袋=2/3Kg; 第二袋=1/3Kg Double dose acetylcysteine infusion（Acetaminophen >300μg/ml 或 double nomogram line 以上）第一袋: 200mg/kg in D5W or N/S 500ml IVD over 4 hours 第二袋: 200mg/kg in D5W or N/S 1000ml IVD over 16 hours 藥物治療結束前2小時re-check GPT + Acetaminophen level + PT；如果 GPT>50U/L 或 Acetaminophen>10 μg/ml 則繼續治療12小時然後re-check data 哪時候要停藥?(4個條件都要符合) ➢GPT下降 ➢INR<2.0 ➢Acetaminophen<10 μg/ml ➢病人無症狀

⚠ 適用限制｜本工具為**高醫院內兩袋法**（2021/12/09 版）之劑量計算；是否啟動治療、Standard 或 Double dose 之選擇，依院內流程圖（nomogram／多次服用／時間不明三條路徑）與 GPT、Acetaminophen level、PT 判定，本工具不替代。院內流程未載明體重上限（澳紐指引以 110 kg 計算上限），超重病人請依藥局／毒物科意見。MDCalc 三袋法（150/50/100 mg/kg）與口服 72 小時法未採用，原文保留如下供對照。

Regimen（依院內流程圖）

Weight (kg)

來源：高醫 Acetaminophen(乙醯胺酚)中毒處理原則 2021/12/09 版；Rumack BH, Peterson RC, Koch GG, Amara IA. Acetaminophen overdose: 662 cases with evaluation of oral acetylcysteine treatment. Arch Intern Med. 1981;141:380-5.
MDCalc：https://www.mdcalc.com/calc/568/acetaminophen-overdose-nac-dosing

Brief Alcohol Withdrawal Scale (BAWS)BAWS 簡式酒精戒斷量表

CIWA-Ar for Alcohol WithdrawalCIWA-Ar 酒精戒斷評估

Columbia Suicide Severity Rating Scale (C-SSRS)C-SSRS 哥倫比亞自殺嚴重度量表

HEADS-EDHEADS-ED 兒少心理社會篩檢

Acetaminophen Overdose and NAC DosingAcetaminophen 過量 NAC 劑量

Brief Alcohol Withdrawal Scale (BAWS)
BAWS 簡式酒精戒斷量表

CIWA-Ar for Alcohol Withdrawal
CIWA-Ar 酒精戒斷評估

Columbia Suicide Severity Rating Scale (C-SSRS)
C-SSRS 哥倫比亞自殺嚴重度量表

HEADS-ED
HEADS-ED 兒少心理社會篩檢

Acetaminophen Overdose and NAC Dosing
Acetaminophen 過量 NAC 劑量