Widget:Alcohol Withdrawal Calc: Difference between revisions
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</script> | </script> | ||
<form name="AWCalc" id="AWCalc"> | <form name="AWCalc" id="AWCalc"> | ||
<b>Nausea and Vomitting</b><br /> | |||
<input type="radio" id="q1" name="q1" value="0" checked /> No nausea or vomiting<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="4" /> Intermittent nausea with dry heaves<br /> | ||
<input type="radio" id="q1" name="q1" value="7" /> Constant nausea, frequent dry heaves and vomiting<br /> | <input type="radio" id="q1" name="q1" value="7" /> Constant nausea, frequent dry heaves and vomiting<br /> | ||
<br /> | <br /> | ||
<b>Paroxysmal Sweats</b><br /> | |||
<input type="radio" name="q2" value="0" checked /> No sweats visible<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="1" /> Barely perceptible sweat, palms moist<br /> | ||
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<input type="radio" name="q2" value="7" /> Drenching sweats<br /> | <input type="radio" name="q2" value="7" /> Drenching sweats<br /> | ||
<br /> | <br /> | ||
<b>Agitation</b><br /> | |||
<input type="radio" name="q3" value="0" checked /> Normal activity<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="1" /> Somewhat more than normal activity<br /> | ||
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<input type="radio" name="q3" value="7" /> Paces back and forth during most of the interview or constantly thrashes about<br /> | <input type="radio" name="q3" value="7" /> Paces back and forth during most of the interview or constantly thrashes about<br /> | ||
<br /> | <br /> | ||
<b>Visual Disturbances</b><br /> | |||
<input type="radio" name="q4" value="0" checked /> Not present<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="1" /> Very mild photosensitivity<br /> | ||
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<input type="radio" name="q4" value="7" /> Continuous visual hallucinations<br /> | <input type="radio" name="q4" value="7" /> Continuous visual hallucinations<br /> | ||
<br /> | <br /> | ||
<b>Tremor</b><br /> | |||
<input type="radio" name="q5" value="0" checked /> No 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="1" /> Not visible, but can be felt at finger tips<br /> | ||
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<input type="radio" name="q5" value="7" /> Severe, even with arms not extended<br /> | <input type="radio" name="q5" value="7" /> Severe, even with arms not extended<br /> | ||
<br /> | <br /> | ||
<b>Tactile Disturbances</b><br /> | |||
<input type="radio" name="q6" value="0" checked /> Not present<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="1" /> Very mild paraesthesias<br /> | ||
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<input type="radio" name="q6" value="7" /> Continuous paraesthesias<br /> | <input type="radio" name="q6" value="7" /> Continuous paraesthesias<br /> | ||
<br /> | <br /> | ||
<b>Headache</b><br /> | |||
<input type="radio" name="q7" value="0" checked /> Not present<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="1" /> Very mild<br /> | ||
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<input type="radio" name="q7" value="7" /> Extremely severe<br /> | <input type="radio" name="q7" value="7" /> Extremely severe<br /> | ||
<br /> | <br /> | ||
<b>Auditory Disturbances</b><br /> | |||
<input type="radio" name="q8" value="0" checked /> Not present<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="1" /> Very mild harshness or ability to frighten<br /> | ||
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<input type="radio" name="q8" value="7" /> Continuous hallucinations<br /> | <input type="radio" name="q8" value="7" /> Continuous hallucinations<br /> | ||
<br /> | <br /> | ||
<b>Orientation and Clouding of the Sensorium</b><br /> | |||
<input type="radio" name="q9" value="0" checked /> Oriented and can do serial additions<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="1" /> Cannot do serial additions<br /> | ||