APACHE II Bedside Entry

Patient

Enter the patient’s full name as per hospital record and their UHID (the hospital’s unique health identifier).

Patient Name*

UHID* Looking for duplicates…

Age in years, biological sex, and the date of ICU admission. “Diagnosis” is the primary working diagnosis at ICU admission.

Age (years)*

Sex*

Admission Date*

Diagnosis*

GCS (3–15)*

Mark severe chronic organ failure/immunocompromise. If present, specify surgical context for this admission.

No Yes – severe organ failure / immunocompromise

Vitals, oxygenation choice (PaO₂ vs A–a gradient based on FiO₂), and key labs for APACHE II calculation.

Temperature (°F)*

Mean Arterial Pressure (mmHg)*

Heart Rate (bpm)*

Respiratory Rate (breaths/min)*

FiO₂ category*

< 50% (or non-intubated) ≥ 50%

PaO₂ (mmHg)*

If FiO₂ < 50% → provide PaO₂.

pH (arterial)

HCO₃⁻ (mEq/L)

Na⁺ (mEq/L)*

K⁺ (mEq/L)*

Creatinine (mg/dL)*

WBC (×10³/mm³)*

Hematocrit (%)*

Acute Renal Failure

No Yes

Mortality (Y/N)*

Y N