Septic Shock Score

Patient's age

Patient's gender

Body weight

Body height

Glasgow Coma Score

Diuresis

Body temperature

Hematocrit (enter 0 to 100)

WBC count

Arterial blood pH

Prothrombin time,

Heart rate

Mean arterial blood pressure

Mean pulmonary artery pressure

Cardiac output

Is the patient on mechanical ventilation?

Does the patient have hepatic cirrhosis?

Does the patient have pre-existing heart failure (NYHA functional class III or IV)?

Does the patient have chronic pulmonary failure?

Does the patient have chronic renal failure?

Has the patient recently received immunosuppressive therapy?

Has the patient recently received chemotherapy?

Has the patient recently received radiation therapy?

Has the patient recently received high dose steroid therapy?

Does the patient have positive blood cultures with more than one pathogen identified?

Are cultures positive for Pseudomonas aeruginosa?

Is pneumonia a primary focus of infection?