DIAG|\OSTIC CRIIERIA FOR iijYROr'f STCRi',!

BURCH ,AND VVARTOFSK'/

1. Thermoregulation dysfunction
Temperature 37,2-37,7 C
37,9-39,3 C
'38,4-38,8 C
38,$39,4 C
39,5-39,9 C
>40c
2. Central Nervous System Effect
Absent
Mild Agitation
Moderate Delirium
Physocis
Extreme Lethargy
Severe Seizure
Coma
3. Gastrointestinal Hepatic Dysfunction
Absent
Moderate Diarrhea
Nausea /vomiting
abdominal pain
Severe unexplained jaundice
4. Cardiovascular Dysfunction
Tachycardia 9G.1O9
110-1 19
120-1,29
130-139
> 140
CHF

. Absent
Mild: oedema
Moderate : bibasiler rales
Severe : pulmonary ederna
AF
Absent
Present

5. Precipitant History
Negative
Positive

Total
 Nama V4rrq+rl MR:
(,4 si
Umur:
3U 4- Ruangan :

lndex W
Tanssal Pemeriksaan

Dyspneu d'eff,ort lnterpretasi

Palpitasi
Fatique lndex Wayne :

Suka udara dingin Euthyroid

suka udara panas
Over sweating
Gugup
petite naik lndex New Castle
Appetite turun uthyroid 11-23
BB naik
BB turun Ferthvroid 40-80

T3
Palpable thyroid T4
Bruit FT3
Exopthalmus FT4
Eye lid lag TSH
Hyperkinetik {gelisah}
Fine finger tremor Uptake
tangan hangat z Jam
tangan basah 24 jam
AF
Nadi < BOx,/' USG thy,roid :
Nadi B0-9Ox/'
Nadi >90x/'
Scanning thyroid
Jumlah

lndex New Castle

Usia saat mulai

Physiological precipitate -5 15-20 0
Frequent checking -3 25-34 4
Severe anticip. Anxiety -5 35-44 8
ite naik 5 45-54 L2
Palpable thyroid 4 >55 16
Bruit 1B
Exopthalmus T9 Heart Rate
Lid retraction 9 >99 :l-6
Hyperkinetik {gelisa h) 4 80-90 B
Fine finger tremor 4 <80 0
Heart rate

Juml.rh