Widget:Alcohol Withdrawal Calc: Difference between revisions
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<form name="AWCalc" id="AWCalc"> | <form name="AWCalc" id="AWCalc"> | ||
Nausea and Vomitting<br /> | Nausea and Vomitting<br /> | ||
<input type="radio" id="q1" name="q1" value="0" checked /> No nausea or vomiting<br /> | |||
<input type="radio" id="q1" name="q1" value="4" /> Intermittent nausea with dry heaves<br /> | |||
<input type="radio" id="q1" name="q1" value="7" /> Constant nausea, freuent dry heaves and vomiting<br /> | |||
<br /> | <br /> | ||
Paroxysmal Sweats<br /> | Paroxysmal Sweats<br /> | ||
<input type="radio" name="q2" value="0" checked /> No sweats visible<br /> | |||
<input type="radio" name="q2" value="1" /> Barely perceptible sweat, palms moist<br /> | |||
<input type="radio" name="q2" value="4" /> Beads of sweat obvious on forehead<br /> | |||
<input type="radio" name="q2" value="7" /> Drenching sweats<br /> | |||
<br /> | <br /> | ||
Agitation<br /> | Agitation<br /> | ||
<input type="radio" name="q3" value="0" checked /> Normal activity<br /> | |||
<input type="radio" name="q3" value="1" /> Somewhat more than normal activity<br /> | |||
<input type="radio" name="q3" value="4" /> Moderate fidgety and restless<br /> | |||
<input type="radio" name="q3" value="7" /> Paces back and forth during most of the interview or constantly thrashes about<br /> | |||
<br /> | <br /> | ||
Visual Disturbances<br /> | Visual Disturbances<br /> | ||
<input type="radio" name="q4" value="0" checked /> Not present<br /> | |||
<input type="radio" name="q4" value="1" /> Very mild photosensitivity<br /> | |||
<input type="radio" name="q4" value="2" /> Mild photosensitivity<br /> | |||
<input type="radio" name="q4" value="3" /> Moderate photosensitivity<br /> | |||
<input type="radio" name="q4" value="4" /> Moderately severe visual hallucinations<br /> | |||
<input type="radio" name="q4" value="5" /> Severe visual hallucinations<br /> | |||
<input type="radio" name="q4" value="6" /> Extreme severe visual hallucinations<br /> | |||
<input type="radio" name="q4" value="7" /> Continuous visual hallucinations<br /> | |||
<br /> | <br /> | ||
Tremor<br /> | Tremor<br /> | ||
<input type="radio" name="q5" value="0" checked /> No tremor<br /> | |||
<input type="radio" name="q5" value="1" /> Not visible, but can be felt at finger tips<br /> | |||
<input type="radio" name="q5" value="4" /> Moderate when patient’s hands extended<br /> | |||
<input type="radio" name="q5" value="7" /> Severe, even with arms not extended<br /> | |||
<br /> | <br /> | ||
Tactile Disturbances<br /> | Tactile Disturbances<br /> | ||
<input type="radio" name="q6" value="0" checked /> Not present<br /> | |||
<input type="radio" name="q6" value="1" /> Very mild paraesthesias<br /> | |||
<input type="radio" name="q6" value="2" /> Mild paraesthesias<br /> | |||
<input type="radio" name="q6" value="3" /> Moderate paraesthesias<br /> | |||
<input type="radio" name="q6" value="4" /> Moderately severe paraesthesias<br /> | |||
<input type="radio" name="q6" value="5" /> Severe paraesthesias<br /> | |||
<input type="radio" name="q6" value="6" /> Extremely severe paraesthesias<br /> | |||
<input type="radio" name="q6" value="7" /> Continuous paraesthesias<br /> | |||
<br /> | <br /> | ||
Headache<br /> | Headache<br /> | ||
<input type="radio" name="q7" value="0" checked /> Not present<br /> | |||
<input type="radio" name="q7" value="1" /> Very mild<br /> | |||
<input type="radio" name="q7" value="2" /> Mild<br /> | |||
<input type="radio" name="q7" value="3" /> Moderate<br /> | |||
<input type="radio" name="q7" value="4" /> Moderately severe<br /> | |||
<input type="radio" name="q7" value="5" /> Severe<br /> | |||
<input type="radio" name="q7" value="6" /> Very severe<br /> | |||
<input type="radio" name="q7" value="7" /> Extremely severe<br /> | |||
<br /> | <br /> | ||
Auditory Disturbances<br /> | Auditory Disturbances<br /> | ||
<input type="radio" name="q8" value="0" checked /> Not present<br /> | |||
<input type="radio" name="q8" value="1" /> Very mild harshness or ability to frighten<br /> | |||
<input type="radio" name="q8" value="2" /> Mild harshness or ability to frighten<br /> | |||
<input type="radio" name="q8" value="3" /> Moderate harshness or ability to frighten<br /> | |||
<input type="radio" name="q8" value="4" /> Moderately severe hallucinations<br /> | |||
<input type="radio" name="q8" value="5" /> Severe hallucinations<br /> | |||
<input type="radio" name="q8" value="6" /> Extremely severe hallucinations<br /> | |||
<input type="radio" name="q8" value="7" /> Continuous hallucinations<br /> | |||
<br /> | <br /> | ||
Orientation and Clouding of the Sensorium<br /> | Orientation and Clouding of the Sensorium<br /> | ||
<input type="radio" name="q9" value="0" checked /> Oriented and can do serial additions<br /> | |||
<input type="radio" name="q9" value="1" /> Cannot do serial additions<br /> | |||
<input type="radio" name="q9" value="2" /> Disoriented for date but not more than 2 calendar days<br /> | |||
<input type="radio" name="q9" value="3" /> Disoriented for date by more than 2 calendar days<br /> | |||
<input type="radio" name="q9" value="4" /> Disoriented for place/person<br /> | |||
<br /> | <br /> | ||
<br /> | <br /> | ||