R-I-S-C Prism

Prathap V Rao Bandipalliam

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R-I-S-C Prism App – The "Composite vital sign"© and clinical “MEASURE”© [Multi-organ system Emergency And Severity Urgent Risk Evaluation] calculator

The emergent patient evaluation includes the initial examination of the vital clinical parameters – e.g. Airway, Breathing & Circulation

We could also summarize the initial important clinical parameters (that we must immediately evaluate) with the checklist “R-I-S-C” – i.e. the Responsiveness (consciousness/GCS), Imminent / acute upper airway obstruction, Increased or decreased temperature, Saturation/breathing status (i.e. the respiratory rate & oxygenation) & Circulation/hemodynamics status (i.e. the heart rate & blood pressure). [these also correspond with the Airway, Breathing, Circulation & Disability (“A-B-C-D”s) of the advanced cardiovascular life support (ACLS), the advanced trauma life support (ATLS) & the pediatric advanced life support (PALS) training].

The Emergency severity “R-I-S-C” score (that is calculated with several commonly collected vital-signs) would give us a more objective initial estimate of the combined various multi-organ system parameters’ clinical stability & also the illness severity [i.e. the "Composite vital sign"© and clinical “MEASURE”© – Multi-organ system Emergency And Severity Urgent Risk Evaluation]. Hence, this would serve as a more precise marker of the overall clinical status, than each of the vital signs alone. We could also compute such a score quickly & intuitively with just the basic bedside point-of-care tests & exams.

Along with the R-I-S-C score, we also have a color-coded risk triangle display, and when the score is very elevated there is also a caution sign & an audio alarm tone. Also, when the “GCS ≤8” option is selected, the Airway option is automatically marked at least “At risk”, underscoring that airway precautions/protection is most likely necessary.

The more elevated the score, the more emergent & critical the illness severity and we could use this in the initial triage process. We could also use this R-I-S-C score subsequently as a sequential guide to monitor the immediate course of the illness (e.g. whether increasing or improving etc.).


We also have more details about the emergent medical management topics at these websites

American Heart Association – Advanced Cardiovascular Life-Support
https://www.ahajournals.org/doi/10.1161/CIR.0000000000000918

American College of Surgeons – Shock / Advanced Trauma Life-Support
https://www.facs.org/~/media/files/education/core%20curriculum/shock.ashx

Society of Critical Care Medicine (US) and European Society of Intensive Care Medicine
https://www.sccm.org/Research/Quality/Sepsis-Definitions

Journal of the American Heart Association
https://www.ahajournals.org/doi/full/10.1161/JAHA.119.011991

American College of Cardiology
http://www.onlinejacc.org/content/71/19/e127

American Thoracic Society
https://www.thoracic.org/professionals/clinical-resources/critical-care/clinical-education/mechanical-ventilation/respiratory-failure-mechanical-ventilation.pdf

European Respiratory Society
https://erj.ersjournals.com/content/22/47_suppl/3s

American Society of Anesthesiologists – Airway Management
https://pubs.asahq.org/anesthesiology/article/118/2/251/13535/Practice-Guidelines-for-Management-of-the?_ga=2.127778501.911922357.1605694824-1527949363.1584602639

Association of Anaesthetists
https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.14779

Glasgow Coma Scale
https://www.glasgowcomascale.org/

American Association of Neurological Surgeons
https://thejns.org/view/journals/j-neurosurg/aop/article-10.3171-2020.6.JNS20992/article-10.3171-2020.6.JNS20992.xml

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