NAJM

ICU CALCULATOR

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NAJM

ICU CALCULATOR

Welcome to Najm

A bedside reference for ICU calculations.
Fast, offline, and open about its sources.

Core ICU calculators

Common formulas and scores for daily ICU practice.

Fast & Efficient

Results in seconds, working offline at the bedside.

Sourced

Dose ranges and formulas follow the references listed under About. Check them against your local protocol.

Made for ICU Professionals

Designed by clinicians, for clinicians. By Dr. Mohamed Najm.

Before you use it

For ICU/CCU doctors, pharmacists and nurses who already know these drugs and scores. It does the arithmetic; the clinical decision stays with you.

Not prospectively validated. Decision support only. Check every result against your protocol and the drug label.

Version 1.5.9 · last reviewed 05 November 2026 · what you enter stays in this browser.

NAJM ICU / CCU
Saved on this device
cm
yr
—kg
—m²
—mL/min

Infusion Doses

Live ranges by weight + drip rate at standard concentrations.

Dose ranges: Marino, The ICU Book, 5th ed., 2023. Default concentrations are common preparations; confirm yours.

Common ICU Antibiotics

Empiric doses with renal adjustment by CrCl.

CrCl —
Sources: Sanford Guide to Antimicrobial Therapy, 2024; IDSA/ATS HAP/VAP guideline, 2016.

Hemodynamics

MAP, shock index, CPP, pressor load, QTc.

QTc Calculator

Bazett · Fridericia · Framingham formulas. Verify before QT-prolonging drugs.
ms
bpm
Bazett QTc (QT/√RR)—
Fridericia QTc (QT/∛RR)—
Framingham QTc—
Enter QT (ms) + HR to compute. Fridericia preferred at HR < 60 or > 100.
Source: Bazett, Heart 1920 · Fridericia, Acta Med Scand 1920 · Sagie (Framingham), Am J Cardiol 1992

Blood Pressure

Enter cuff or arterial line values.
mmHg
mmHg
bpm
MAP—
Pulse Pressure—
Shock Index—
Modified SI—
Enter SBP/DBP to interpret.
Source: Shock index — Allgöwer & Buri, Dtsch Med Wochenschr 1967. Modified SI — Liu YC et al., Am J Emerg Med 2012.

Cerebral Perfusion

CPP = MAP − ICP. Adults target ≥ 60 mmHg.
mmHg
auto
CPP—
Enter ICP to compute.
Source: Brain Trauma Foundation Guidelines for Severe TBI, 4th ed. Neurosurgery 2017.

Norepi Equivalents

Comparator of vasopressor load (μg/kg/min equivalents).
μg/kg/min
μg/kg/min
μg/kg/min
μg/kg/min
U/min
NE equivalent—
Sum of norepi-equivalent support.
Source: Khanna et al., NEJM 2017

Ventilator

PBW-based TV, Berlin ARDS, driving pressure, ROX index.

ROX Index (HFNC success)

(SpO₂ / FiO₂) / RR — predicts need for intubation during HFNC. Measure at 2 h, 6 h, 12 h.
%
%
/min
ROX Index—
Enter SpO₂, FiO₂ (0.4 or 40), RR. Cut-offs: ≥ 4.88 at 2 h · ≥ 4.88 at 6 h · ≥ 4.88 at 12 h = low intubation risk.
Source: Roca O et al., AJRCCM 2019;199:1368–76

Tidal Volume (Predicted BW)

PBW needs height + sex. Targets: 4 / 6 / 8 mL/kg.
PBW—
TV 4 mL/kg (low)—
TV 6 mL/kg (target)—
TV 8 mL/kg (max ARDS)—
Source: ARDS Network, NEJM 2000

Oxygenation (P/F & SF)

mmHg
%
%
P/F ratio—
SpO₂/FiO₂—
Enter PaO₂ and FiO₂ for Berlin classification.
Source: ARDS Definition Task Force (Berlin), JAMA 2012

Driving Pressure & Compliance

cmH₂O
cmH₂O
mL
Driving pressure—
Static compliance—
Target driving pressure < 15 cmH₂O.
Source: Amato et al., NEJM 2015

Weaning Readiness & RSBI

Daily SBT if criteria met. RSBI = RR / TV (L); < 105 predicts successful extubation (Yang & Tobin NEJM 1991).
/min
mL
RSBI—
Enter RR and TV during SBT (PS 0 – 8 cmH₂O, PEEP ≤ 5) × 30 – 120 min.
SBT + extubation checklist (tap)
  • SBT eligibility: cause of resp failure resolving · FiO₂ ≤ 0.5 and PEEP ≤ 8 · P/F > 150 · haemodynamic stability (MAP ≥ 65 on minimal pressors) · adequate cough / airway reflex · GCS adequate / RASS − 1 to + 1 · pH ≥ 7.30 · Hb ≥ 7 · electrolytes OK.
  • SBT settings: PS 0 – 8 cmH₂O (or T-piece) + PEEP 0 – 5 × 30 – 120 min. CPAP alone acceptable.
  • Pass criteria: RSBI < 105 · RR < 35 · SpO₂ ≥ 90 (or FiO₂ unchanged) · HR < 140 (and no > 20 % change) · SBP 90 – 180 (no > 20 % change) · no respiratory distress (accessory muscles, diaphoresis, agitation).
  • Cuff-leak test (high-risk airway): leak < 110 mL or < 10 – 24 % of TV → high stridor risk → dexamethasone 20 mg or 4 × 5 mg q 6 h × 24 h before extubate.
  • Post-extubation NIV / HFNC: COPD / CHF → NIV cuts reintubation + mortality. Hypoxaemic without hypercapnia → HFNC first-line.
  • Reintubation within 48 h = failure (high mortality). Review cause before next trial (volume overload, cardiac, sputum, mental status, upper airway).
Source: Yang KL & Tobin MJ. A prospective study of indexes predicting the outcome of weaning (RSBI). NEJM 1991;324(21):1445–50. Thille AW et al. HFNC vs NIV after extubation. JAMA 2019;322(15):1465–75.

🫁 ARDS Management Bundle

Berlin 2012 definition — acute (≤ 1 wk) hypoxaemia + bilateral opacities on CXR/CT + not fully explained by cardiac failure/fluid overload. Severity by P/F on PEEP ≥ 5: mild 200 – 300 · moderate 100 – 200 · severe ≤ 100.

1. Lung-protective ventilation (every patient)

TV 6 mL/kg PBW (range 4 – 8 if needed). Use the PBW card above — never actual body weight.
Plateau pressure ≤ 30 cmH₂O (measure 0.5 s inspiratory hold, no spontaneous effort).
Driving pressure (Pplat − PEEP) < 15 cmH₂O — strongest single predictor of mortality (Amato NEJM 2015).
RR 20 – 35 to maintain minute ventilation; permissive hypercapnia OK down to pH ≥ 7.20.
SpO₂ target 88 – 95 %; PaO₂ 55 – 80 (ARDSnet) — avoid hyperoxia.

2. PEEP / FiO₂ titration (ARDSnet lower table)

FiO₂ 0.3 · 0.4 · 0.4 · 0.5 · 0.5 · 0.6 · 0.7 · 0.7 · 0.7 · 0.8 · 0.9 · 0.9 · 0.9 · 1.0
PEEP 5 · 5 · 8 · 8 · 10 · 10 · 10 · 12 · 14 · 14 · 14 · 16 · 18 · 18 – 24
Moderate-severe ARDS: consider higher-PEEP table (ALVEOLI / LOVS / EXPRESS). Titrate to best compliance OR to driving pressure < 15, not to oxygenation alone.

3. Prone positioning — PROSEVA (life-saving in moderate-severe)

Trigger: P/F < 150 on FiO₂ ≥ 0.6 and PEEP ≥ 5 for ≥ 12 h.
Duration: at least 16 h/day × consecutive sessions until P/F ≥ 150 on FiO₂ ≤ 0.6 + PEEP ≤ 10 for 4 h supine.
Mortality benefit: 28-day mortality 16 % vs 32.8 % (NNT 6, PROSEVA NEJM 2013). Needs a trained team; brief sedation and paralysis for the flip. Secure ETT and lines first, protect eyes/pressure points, aspirate before turn.

4. Neuromuscular blockade (short course if severe + asynchrony)

For P/F < 150 with ventilator dyssynchrony despite deep sedation (RASS − 4/− 5):
Cisatracurium 15 mg IV bolus → 37.5 mg/hr infusion × 48 h (ACURASYS protocol).
ROSE trial (2019) showed no mortality benefit vs light sedation — now reserved for severe ARDS with high plateau pressure, dyssynchrony, or difficulty proning. Train-of-four not routinely required at this dose. Stop by 48 h to avoid ICU-acquired weakness.

5. Conservative fluid strategy (FACTT)

After shock resolved (MAP ≥ 60, no vasopressor need), aim for net-zero / negative balance. Use furosemide boluses or infusion if CVP > 4 and UO < 0.5 mL/kg/hr with adequate perfusion.
Benefit: more ventilator-free days (14.6 vs 12.1), shorter ICU stay. No mortality difference — but shorter time on vent.

6. Corticosteroids (moderate-severe, within 14 days)

Dexamethasone 20 mg IV daily × 5 d, then 10 mg × 5 d (DEXA-ARDS, Villar Lancet Resp Med 2020).
COVID-19 ARDS: dexamethasone 6 mg IV/PO × 10 d (RECOVERY).
Avoid if infection unidentified or starting > 14 d from onset. Monitor glucose, infection, bleeding.

7. Rescue therapies (if refractory on bundle above)

Recruitment manoeuvre: brief PEEP 35 – 40 × 40 s or stepwise PEEP escalation — may transiently improve oxygenation; avoid aggressive protocols (ART trial showed harm).
Inhaled vasodilators (iNO 5 – 20 ppm, inhaled epoprostenol 50 ng/kg/min) — oxygenation only, no mortality benefit; bridge to prone/ECMO.
Avoid HFOV in adults (OSCILLATE, OSCAR).

8. VV-ECMO — EOLIA criteria

Refer early (ideally < 7 d of mechanical ventilation):
• P/F < 50 on FiO₂ ≥ 0.8 × 3 h, OR
• P/F < 80 on FiO₂ ≥ 0.8 × 6 h, OR
• pH < 7.25 with PaCO₂ ≥ 60 for > 6 h despite RR 35 and Pplat ≤ 32.
EOLIA (NEJM 2018) + post-hoc Bayesian analysis (Goligher JAMA 2018): mortality 35 % vs 46 %. Contraindications: terminal disease, severe comorbidities, intracranial bleed, prolonged (> 7 d) high-pressure/FiO₂ ventilation.
Use the Murray Lung Injury Score card below to objectively grade severity.

9. Monitoring + weaning

Daily: SBT / spontaneous awakening (SAT) once pressors off, FiO₂ ≤ 0.5, PEEP ≤ 8, Pplat ≤ 25, pH ≥ 7.30, mental status adequate.
Early mobilisation when safe (ABCDEF bundle). Nutrition: enteral < 48 h, trophic feeds initially acceptable (EDEN trial).

Sources: ARDS Definition Task Force (Berlin), JAMA 2012. ARDSnet, NEJM 2000. Guérin PROSEVA, NEJM 2013. Papazian ACURASYS, NEJM 2010 + NHLBI PETAL ROSE, NEJM 2019. Wiedemann FACTT, NEJM 2006. Villar DEXA-ARDS, Lancet Resp Med 2020. Combes EOLIA, NEJM 2018.

Acid–Base / ABG

Primary disorder, compensation, anion gap, Δ-Δ, A–a.

Inputs

mmHg
mEq/L
mEq/L
mEq/L
mmHg
%

Interpretation

Primary disorder—
Expected compensation—
Anion gap—
Corrected AG—
Δ-Δ ratio—
A–a gradient—
Enter pH, PaCO₂, HCO₃ to start.
Source: Winters, Ann NY Acad Sci 1966 (expected compensation)

Electrolytes

Corrections, osmolality, FWD, K⁺ replacement.

Corrected Calcium

Cacorr = Ca + 0.8 × (4 − albumin)
Corrected Ca—
Reference 8.5 – 10.5 mg/dL.
Source: Payne RB et al. BMJ 1973;4(5893):643–6 (albumin-corrected Ca).

Corrected Na (hyperglycemia)

Nacorr = Na + 1.6 × (glucose − 100) / 100
mEq/L
Corrected Na—
Source: Katz MA. NEJM 1973;289(16):843–4 (original) · Hillier TA et al. Am J Med 1999;106(4):399–403 (1.6 factor validated).

Osmolal Gap & Toxic Alcohols

Calc = 2·Na + Glucose/18 + BUN/2.8 (+ EtOH/3.7). Gap = Measured − Calculated.
mEq/L
mg/dL
mOsm/kg
Calculated (with EtOH)—
Calculated (without EtOH)—
Osmolal gap—
Severity band—
Normal gap < 10 mOsm/kg (upper range 6 – 14 in healthy adults).
Toxic alcohol differential (tap)
  • Methanol — HAGMA + ↑gap, retinal/optic Sx, formic acid; antidote: fomepizole, folate, HD if severe.
  • Ethylene glycol — HAGMA + ↑gap, Ca-oxalate crystals in urine, AKI; antidote: fomepizole, thiamine + pyridoxine, HD if severe.
  • Isopropyl alcohol — ↑gap without HAGMA (ketosis without acidosis); supportive care, HD rarely.
  • Propylene glycol — IV lorazepam/phenobarb/TMP-SMX infusions; stop offending agent, HD if severe.
  • Mannitol / glycerol / sorbitol — iatrogenic; ↑gap without acidosis.
  • Severe ketoacidosis (DKA, AKA, starvation) — mild ↑gap from ketones.
  • Lactic acidosis — mild ↑gap from lactate.
Red flag: HAGMA + osm gap > 10 → start fomepizole empirically; call toxicology/nephrology for HD assessment.
Sources: Krasowski et al., BMC Clin Pathol 2012; Kraut & Mullins, NEJM 2018

Free Water Deficit

FWD = TBW × (Na/target − 1). TBW = 0.6·W (M) / 0.5·W (F).
mEq/L
mEq/L
Free water deficit—
Correct ≤ 10 mEq/L per 24 hr to avoid cerebral edema.
Source: Adrogué & Madias, NEJM 2000

Potassium Replacement

Empiric IV KCl guide.
mEq/L
Suggested replacement—
Max peripheral 10 mEq/hr; central 20 mEq/hr with monitoring.
Source: Kraft MD et al. Treatment of electrolyte disorders in adult ICU patients. Am J Health-Syst Pharm 2005;62(16):1663–82.

⚡ Hyperkalemia Emergency Protocol

K⁺ > 6.0 with ECG changes, or K⁺ > 6.5 regardless.

1. Stabilise cardiac membrane (within minutes)

Calcium gluconate 10% 30 mL IV over 10 min (or Ca chloride 10% 10 mL via central). Repeat q10 min if ECG changes persist. Onset 1–3 min, duration 30–60 min.

2. Shift K⁺ intracellularly

Insulin 10 units IV + Dextrose 25 g IV (50 mL D50W). Check glucose q1h × 6 — hypoglycaemia common.
Salbutamol 10–20 mg nebulised. Avoid in tachyarrhythmia.
Sodium bicarbonate only if co-existing metabolic acidosis (not routine).

3. Remove K⁺ from body

Furosemide 20–80 mg IV if volume replete + urine output.
Patiromer 8.4 g PO (or SZC/Lokelma 10 g PO) — slow onset.
Haemodialysis if refractory, severe (K > 6.5 unresponsive), AKI with oliguria, or symptomatic.

4. Monitor + root-cause

Continuous ECG; recheck K⁺ at 1 h and q2h. Stop ACEi/ARB/K-sparing diuretics/trimethoprim. Treat AKI, acidosis, rhabdo, tumour lysis.

🩸 DKA / HHS Protocol

Adult diabetic ketoacidosis / hyperosmolar hyperglycaemic state.

1. Fluids (first hour)

0.9% NaCl 15–20 mL/kg IV over 1 h (1–1.5 L adult). Then 250–500 mL/hr adjusted to haemodynamics. Switch to 0.45% NaCl once corrected Na is normal/high.
Add D5 ½ NS when glucose < 250 mg/dL (14 mmol/L) to allow insulin continuation.

2. Insulin

Check K⁺ FIRST. If K⁺ < 3.3 → hold insulin, replace K⁺ first.
Regular insulin 0.1 U/kg IV bolus, then 0.1 U/kg/hr infusion. Target glucose fall 50–75 mg/dL/hr.
When glucose ≤ 200 (DKA) or ≤ 300 (HHS) → cut infusion in half (0.02–0.05 U/kg/hr) and add dextrose.
Transition to subcutaneous when AG closed + patient eating.

3. Potassium (always deplete!)

K⁺ > 5.2 → no replacement, recheck q2h
K⁺ 3.3–5.2 → 20–30 mEq KCl in each litre of IVF
K⁺ < 3.3 → HOLD insulin, give 20–40 mEq/hr until > 3.3

4. Bicarbonate (rarely)

Only if pH < 6.9: 100 mEq NaHCO₃ in 400 mL water + 20 mEq KCl, over 2 h. Not routine — may worsen hypokalaemia + cerebral acidosis.

5. Monitoring + resolution

q1–2h: glucose, electrolytes (K, Mg, Phos), AG, pH. Resolution: AG < 12, HCO₃ > 15, pH > 7.3, glucose < 200. Treat precipitant (infection, missed insulin, MI, pancreatitis).

Renal & Fluids

CrCl, UO, sepsis bolus, maintenance.

Creatinine Clearance

Cockcroft–Gault: (140 − age) × W / (72 × Cr); × 0.85 (F).
CrCl—
Set age, weight, sex, creatinine in the patient bar.
Source: Cockcroft & Gault, Nephron 1976

Urine Output

Per kg/hr — oliguria < 0.5 mL/kg/hr.
mL
hr
Rate—
Enter volume + hours.
Source: KDIGO AKI guideline, 2012 (oliguria threshold)

Sepsis Fluid Bolus

Surviving Sepsis: 30 mL/kg crystalloid within 3 hr.
Target volume—
¼ bolus (250 mL)—
Reassess after each bolus — avoid over-resuscitation.
Source: Surviving Sepsis Campaign, 2021

Maintenance Fluids (4-2-1)

First 10 kg ×4, next 10 kg ×2, remainder ×1 mL/kg/hr.
Maintenance rate—
Source: Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics 1957;19(5):823–32.

Transfusion Thresholds

Restrictive strategy is standard (TRICC, TRISS, TITRe-2). Transfuse one unit at a time, re-check Hb, re-assess need.
ProductTriggerDose / expected rise
PRBC — general ICUHb < 7 g/dL1 unit → ↑ Hb ~ 1 g/dL
PRBC — ACS / cardiacHb < 8 g/dLsame
PRBC — septic shock (early)Hb < 7 g/dL (TRISS)same
PRBC — active major bleedingClinical, target Hb ≥ 7See MTP card
Platelets — spontaneous bleed risk< 10 × 10⁹/L1 adult dose → ↑ 20 – 40
Platelets — minor procedure, LP, line< 20 – 50same
Platelets — major surgery / neurosurg< 100same
Platelets — active bleedingKeep > 50 (> 100 if CNS)same
FFP — INR > 1.5 + bleeding / pre-procedureINR > 1.5 – 1.710 – 15 mL/kg
CryoprecipitateFibrinogen < 1.5 g/L (bleeding) OR < 2 g/L (obstetric)10 units adult → ↑ fib ~ 0.5 g/L
PCC (4-factor)Warfarin / factor Xa reversal + major bleed25 – 50 U/kg + vit K 10 mg IV
TRALI vs TACO — differential (tap)
FeatureTRALITACO
Onset< 6 h post-transfusion< 6 h, often during
MechanismAnti-HLA / neutrophil Ab → non-cardiogenic pulm oedemaVolume overload — cardiogenic
BPHypotension (classic)Hypertension (classic)
BNPNormalElevated (> 1 200 pg/mL)
LV functionNormalReduced / overloaded
Response to diureticsPoorGood
TreatmentSupportive, lung-protective vent, report donorDiurese, slow / stop transfusion
Source: Hébert TRICC NEJM 1999 · Holst TRISS NEJM 2014 · Hajjar TRACS JAMA 2010 · Carson 2016 AABB guideline. ISBT 2019 TRALI definition.

Nutrition Targets (ICU)

Mifflin-St Jeor REE × stress factor; protein 1.2 – 2.0 g/kg (higher if burns / sepsis / CRRT). Start enteral < 48 h; trophic rate (10 – 20 mL/hr) acceptable early (EDEN).
auto cm
auto yr
REE (Mifflin-St Jeor)—
Target kcal (REE × stress)—
Protein 1.2 g/kg—
Protein 2.0 g/kg (sepsis / CRRT / burns)—
Needs weight, height, age, sex (from patient bar). Overrides above are optional.
Refeeding risk + practical tips (tap)
  • Refeeding risk (NICE): BMI < 16 · ≥ 15 % weight loss in 3 – 6 mo · little/no intake > 10 d · low K/Mg/PO₄ before feeding. Start at 5 – 10 kcal/kg/d, advance slowly over 4 – 7 d; replace K, Mg, PO₄; thiamine 100 – 300 mg IV before feeding.
  • EDEN (NEJM 2012): trophic feeds (10 – 20 mL/hr) non-inferior to full feeds for 6 d in ARDS — ventilator-free days equal.
  • TARGET (NEJM 2018): 1.5 kcal/mL concentrated feed non-inferior to 1.0 kcal/mL in critically ill — no mortality or infection difference.
  • Protein — critical illness: 1.3 g/kg/d (ASPEN/SCCM); 1.5 – 2.0 if burns, trauma, sepsis, CRRT, polytrauma, pressure injury.
  • Parenteral nutrition if enteral contraindicated (bowel obstruction, GI bleed, severe ileus) and ≥ 7 d expected NPO — start low (EPaNIC NEJM 2011).
Source: McClave SA et al. ASPEN / SCCM nutrition support in the adult critically ill patient. JPEN 2016;40(2):159–211. Rice TW et al. EDEN trial, NEJM 2012. NICE CG32 (refeeding).

Parkland Formula (burns)

4 mL × kg × %TBSA of Lactated Ringer's over 24 h — ½ in first 8 h (from time of burn), ½ over next 16 h. Count only 2nd + 3rd degree burns.
%
24-hour total LR—
First 8 hr—
Next 16 hr—
Target urine output—
Enter %TBSA. Weight read from patient bar.
Rule of Nines — adult TBSA reference (tap)
  • Head & neck — 9 %
  • Each upper limb — 9 %
  • Each lower limb — 18 %
  • Anterior trunk — 18 %
  • Posterior trunk — 18 %
  • Perineum — 1 %
  • Palm (patient's own) — ~ 1 % (handy for patchy burns)
Transfer-to-burn-centre criteria (ABA): partial-thickness > 10 % TBSA · any face / hands / feet / genitalia / perineum / major joints · 3rd degree in any age group · electrical / chemical / inhalation injury · burn with trauma / co-morbidity / child in a non-paediatric centre.
Source: Baxter CR & Shires GT, Ann NY Acad Sci 1968;150:874–94 (Parkland); ABA criteria 2016.

🩸 Massive Transfusion Protocol (MTP)

Trigger: ABC score ≥ 2, SI > 1 with ongoing bleeding, > 10 units PRBC/24 h anticipated, or > 4 units in 1 h.

1. Ratio-based resuscitation (1 : 1 : 1)

For every 6 units PRBC → 6 units FFP → 1 adult dose platelets (= 1 apheresis unit or 6-pack).
Order by MTP pack. Resist crystalloid > 1 L (dilutes clotting factors).

2. Adjunctive haemostatic drugs

Tranexamic acid 1 g IV over 10 min, then 1 g over 8 h — give within 3 h of trauma (CRASH-2).
Fibrinogen replacement: cryoprecipitate 10 units (adult) or fibrinogen concentrate 2–4 g if fibrinogen < 1.5 g/L.
Prothrombin complex (PCC) 25–50 U/kg for warfarin / Xa reversal + major haemorrhage.
DDAVP 0.3 mcg/kg IV if uraemic bleeding / aspirin.

3. Correct the lethal triad

Hypothermia: warm all fluids (37 °C), forced-air warmer, cover head.
Acidosis: treat shock first; bicarbonate only if pH < 7.1 persisting.
Coagulopathy: see ratio above; add TXA + fibrinogen + Ca.

4. Monitor + endpoints

q 30 min: TEG/ROTEM if available, INR, fibrinogen, ionised Ca (target > 1.1 — give 1 g Ca gluconate per 4 units blood), K⁺, lactate, temp.
Stop MTP when haemodynamically stable, SBP > 90 for 30 min, HR < 110, no further transfusion requirement in 30 min, source controlled.

5. Target values

Hb 7–9 · platelets > 50 (> 100 if head injury / ongoing haemorrhage) · fibrinogen > 1.5–2 · INR < 1.5 · ionised Ca > 1.1 · temp > 36 °C · pH > 7.2 · base deficit < 6.

Clinical Scores

Live scoring with interpretation.

GCS

Glasgow Coma Scale (3–15)
Source: Teasdale G & Jennett B. Lancet 1974;2(7872):81–4.

qSOFA

≥ 2 → higher sepsis mortality risk.
Source: Singer M et al. Sepsis-3. JAMA 2016;315(8):801–10.

SOFA

Organ dysfunction (0–24).
Source: Vincent et al., Intensive Care Med 1996

CHA₂DS₂-VASc

Stroke risk in AF.
Source: ESC AF guidelines, 2020

HAS-BLED

Bleeding risk on anticoagulation.
Source: ESC AF guidelines, 2020

Wells (PE)

Pretest probability of PE.
Source: ESC PE guidelines, 2019

RASS

Richmond Agitation–Sedation Scale.
Source: Sessler et al., Am J Respir Crit Care Med 2002

Modified Duke Criteria

Infective endocarditis diagnosis — 2 major, or 1 major + 3 minor, or 5 minor = Definite IE.
Source: Li JS et al., Clin Infect Dis 2000;30:633–8 (modified Duke)

APACHE II

ICU mortality prediction — use the worst value in first 24 h of admission.
Source: Knaus WA et al., Crit Care Med 1985;13:818–29

HEART Score

6-week MACE risk for undifferentiated chest pain in ED.
Source: Six AJ et al., Neth Heart J 2008;16(6):191–6

TIMI (UA/NSTEMI)

14-day risk of death / new MI / urgent revascularisation.
Source: Antman EM et al., JAMA 2000;284(7):835–42

CURB-65

Pneumonia severity — triages outpatient vs inpatient vs ICU.
Source: Lim WS et al., Thorax 2003;58(5):377–82

ICH Score

30-day mortality after spontaneous intracerebral haemorrhage.
Source: Hemphill JC et al., Stroke 2001;32(4):891–7

NIHSS

NIH Stroke Scale — 11 items, 0–42. Used for tPA eligibility, severity staging, and serial neuro checks.
Source: Brott T et al., Stroke 1989;20(7):864–70

Hunt & Hess (SAH)

Clinical grading of subarachnoid haemorrhage — predicts surgical mortality.
Source: Hunt WE & Hess RM, J Neurosurg 1968;28(1):14–20

Modified Fisher (SAH)

CT grading of SAH thickness + IVH — predicts symptomatic vasospasm risk.
Source: Frontera JA et al., Neurosurgery 2006;59(1):21–7

Child-Pugh

Cirrhosis severity — A (5–6), B (7–9), C (10–15).
Source: Pugh RN et al., Br J Surg 1973;60(8):646–9

CAM-ICU

Confusion Assessment Method for the ICU — delirium screen in intubated/non-verbal patients. Positive = Feature 1 + 2 + (3 OR 4).
Source: Ely EW et al., JAMA 2001;286(21):2703–10

Padua VTE

Medical-inpatient VTE risk. Score ≥ 4 → start pharmacologic prophylaxis.
Source: Barbar S et al., J Thromb Haemost 2010;8(11):2450–7

Murray Lung Injury Score

4-item ARDS severity. Average (sum ÷ 4): 0 = no injury · 0.1–2.5 = mild-mod · > 2.5 = severe (ECMO criterion).
Source: Murray JF et al., Am Rev Respir Dis 1988;138(3):720–3

MELD-Na

90-day mortality in cirrhosis; drives liver-transplant priority (UNOS, Feb 2016+). Range 6–40.
mg/dL
mg/dL
mEq/L
MELD—
MELD-Na—
Enter bilirubin, INR, creatinine, sodium.
Source: Kim WR et al., NEJM 2008;359(10):1018–26 (MELD-Na); OPTN/UNOS policy 2016.

Vancomycin AUC₂₄ (bedside estimate)

Target AUC₂₄ = 400 – 600 mg·h/L for serious MRSA (ASHP/IDSA 2020). Simplified estimate: AUC₂₄ ≈ daily dose / (0.045 × CrCl).
mg
hr
auto
Daily dose—
CrCl used—
Estimated AUC₂₄—
Loading dose (25–30 mg/kg)—
Enter dose. CrCl is auto-filled from the patient bar.
Source: Rybak MJ et al., ASHP/IDSA/PIDS/SIDP vancomycin consensus guideline. Am J Health-Syst Pharm 2020;77(11):835–64.

Shift Notes

Scratchpad, stored unencrypted in this browser only. Don’t write names, MRNs, dates of birth or bed numbers: ward computers are often shared.

Antidotes

Toxicology reversal · overdose antidotes · NMB reversal.

🚨 Rapid Sequence Intubation

Bedside protocol — the 7 P's, all induction agents, paralytics, pre-treatment, and reversal.

The 7 P's

RSI Drug Reference

Doses at a glance — pre-treat → induce → paralyse → reverse.

Neuroprotective Strategy

Bedside bundle for TBI, SAH, ischemic stroke, ICH and post-arrest care. Check it against your unit’s protocol.

⚡ Status Epilepticus Protocol

Convulsive status epilepticus = ≥ 5 min continuous seizure OR ≥ 2 seizures without recovery. Treat as emergency — brain injury begins at 30 min of continuous activity.

0 – 5 min · Stabilisation

ABC · O₂ · IV access · attach monitor · finger-stick glucose immediately.
Labs: electrolytes (Na, Mg, Ca, PO₄), BUN, LFT, CBC, toxicology, AED levels, pregnancy test (women of reproductive age), ABG, blood culture if febrile.
If hypoglycaemia → thiamine 100 mg IV THEN dextrose 25 g IV (D50 50 mL).

5 – 20 min · Initial therapy (benzodiazepine)

Choose ONE, give full dose, repeat ONCE if seizures continue:
• Midazolam 10 mg IM (adult ≥ 40 kg) — preferred when no IV, superior to IV lorazepam in RAMPART trial.
• Lorazepam 0.1 mg/kg IV (max 4 mg) over 2 min — gold standard with IV access.
• Diazepam 0.15 – 0.2 mg/kg IV (max 10 mg) over 2 min — short duration, follow with 2nd-line.
Underdosing is the commonest error — give the FULL dose.

20 – 40 min · Second-line therapy

Pick ONE (no evidence of superiority between the three — ESETT trial):
• Levetiracetam 60 mg/kg IV (max 4 500 mg) over 10 min — fewest drug interactions.
• Fosphenytoin 20 mg PE/kg IV (max 1 500 mg PE) at ≤ 150 mg PE/min — cardiac monitor, avoid in heart block / torsades.
• Valproate 40 mg/kg IV (max 3 000 mg) over 10 min — avoid in hepatic failure, mitochondrial disease, pregnancy.

40 – 60 min · Refractory status — intubate + anaesthetic infusion

Intubate (RSI tab). Start continuous EEG. Choose ONE anaesthetic — target burst suppression × 24 – 48 h, then wean:
• Midazolam 0.2 mg/kg bolus → 0.05 – 2 mg/kg/hr infusion (titrate every 5 min).
• Propofol 1 – 2 mg/kg bolus → 20 – 200 μg/kg/min (watch for PRIS at > 80 μg/kg/min > 48 h).
• Pentobarbital 5 – 15 mg/kg bolus (≤ 50 mg/min) → 0.5 – 5 mg/kg/hr — hypotension, ileus common, prolonged recovery.

Super-refractory (> 24 h) — adjuncts

Ketamine 1 – 5 mg/kg/hr · hypothermia 32 – 35 °C · magnesium 4 g IV (eclampsia) · pyridoxine 70 mg/kg (INH toxicity, infants) · ketogenic diet · immunotherapy (steroids, IVIG, plasmapheresis) · surgery for lesional cases.

Monitoring + special situations

Continuous EEG mandatory in refractory + after convulsions stop (non-convulsive SE in ≥ 20 % of persistent coma post-SE).
Eclampsia: MgSO₄ 4 – 6 g IV loading → 1 – 2 g/hr; deliver fetus.
Alcohol withdrawal: benzodiazepines + thiamine; avoid phenytoin (ineffective).
Toxic: INH → pyridoxine · TCA → NaHCO₃ · theophylline → HD · cocaine → benzos.

Source: Glauser T et al. Evidence-based guideline — treatment of convulsive status epilepticus (NCS). Epilepsy Curr 2016;16(1):48–61. ESETT investigators, NEJM 2019;381(22):2103–13. RAMPART (Silbergleit), NEJM 2012;366(7):591–600.

🧠 ABCDEF ICU Liberation Bundle

SCCM ICU Liberation / PADIS 2018. Daily implementation cuts mortality (OR 0.68), delirium (OR 0.60), coma, physical restraint, discharge-home disability, 7-day readmission. Round on every element every shift.

A · Assess, prevent and manage PAIN

Tool: CPOT ≥ 3 (non-verbal) OR NRS ≥ 4 (verbal) = pain.
Treat pain FIRST before adding sedation (analgo-sedation).
First-line: fentanyl 25 – 100 μg/hr infusion, titrate to CPOT < 3. Avoid morphine in renal failure (metabolite accumulation).
Adjuncts: paracetamol 1 g IV q 6 h · ketamine 0.1 – 0.5 mg/kg/hr for opioid-sparing · gabapentin / regional blocks if appropriate. Avoid long-term NSAIDs in critical illness.

B · BOTH Spontaneous Awakening (SAT) + Spontaneous Breathing Trial (SBT)

SAT safety: no active seizures, no alcohol withdrawal, no neuromuscular blockade, no agitation on current sedation, no myocardial ischaemia in prior 24 h, no ↑ICP.
SAT = stop sedation (± opioid continued for pain). If RASS ≥ − 1 within 4 h → go to SBT.
SBT: see the Weaning Readiness card in Ventilator tab for criteria + RSBI.
Awake Breathing Controlled trial (ABC, Girard Lancet 2008): more vent-free days (14.7 vs 11.6), lower 1-yr mortality (44 vs 58 %).

C · Choice of analgesia and sedation

Target light sedation: RASS 0 to − 2 unless specific indication for deeper (ARDS prone, severe asynchrony, ↑ICP, status epilepticus).
Prefer non-benzodiazepines:
• Propofol 5 – 50 μg/kg/min (watch PRIS > 80 μg/kg/min > 48 h)
• Dexmedetomidine 0.2 – 1.5 μg/kg/hr (SPICE-III, MENDS2: non-inferior to propofol, less delirium in some trials)
Avoid benzodiazepine infusions (midazolam, lorazepam) unless alcohol/benzo withdrawal or refractory status.
Reassess sedation level + need q 4 h.

D · Delirium — assess, prevent, manage

Assess: CAM-ICU each shift (see Scores tab) + RASS first.
Prevent: re-orientate, open blinds in day / dim at night, hearing aids / glasses on, early mobility, family at bedside, pain + sedation per above, avoid tethers.
Manage (DELIRIUMS mnemonic — find a cause): Drugs (anticholinergics, steroids, opioids, benzos) · Electrolytes / endocrine (Na, Ca, Mg, glucose, thyroid) · Low O₂ (hypoxia, hypoperfusion, anaemia, MI) · Infection / sepsis · Retention (urinary, faecal) · Ictal / post-ictal · Under-hydration / under-nutrition · Metabolic (uraemia, hepatic encephalopathy, acid-base) · Subdural / stroke / CNS.
Pharmacology: antipsychotics (haloperidol 2 – 5 mg IV q 4 – 6 h, olanzapine, quetiapine 25 – 100 mg BID) only for severe agitation / safety — no mortality benefit (MIND-USA). Dexmedetomidine for hyperactive delirium at night.

E · Early mobility and exercise

Begin ROM within 24 – 48 h of ICU admit when haemodynamically stable (MAP ≥ 65 off escalating pressors, FiO₂ ≤ 0.6, PEEP ≤ 10, no active ischaemia / arrhythmia).
Progression: passive ROM → active ROM → sitting edge of bed → standing → marching → walking in room → walking in corridor.
Needs 2 – 3 staff + physio + RT; portable ventilator OK. Mobility within 72 h cuts ICU LOS by 1.5 d (Schweickert Lancet 2009).

F · Family engagement + empowerment

Open / flexible visitation. Involve family in rounds, delirium prevention (orientation, familiar objects, voice recordings), SAT/SBT coaching.
Daily communication: diagnosis, prognosis, goals of care, estimated LOS. Document family meetings. Offer palliative care consult when prognosis guarded.
ICU diary, follow-up clinic reduces PTSD (RACHEL, Jones et al.).

Sources: Devlin JW et al. PADIS Guidelines — Pain, Agitation/Sedation, Delirium, Immobility, Sleep. Crit Care Med 2018;46(9):e825–73. Pun BT et al. Caring for critically ill patients with the ABCDEF bundle — ICU Liberation Collaborative. Crit Care Med 2019;47(1):3–14. Girard TD et al. ABC trial. Lancet 2008;371(9607):126–34. Schweickert WD et al. Early physical and occupational therapy. Lancet 2009;373(9678):1874–82. Girard TD et al. MIND-USA — haloperidol/ziprasidone for delirium in ICU. NEJM 2018;379(26):2506–16.

Sepsis & Septic Shock

Surviving Sepsis Campaign 2021 — bedside bundle, resuscitation, pressors, source control, adjuncts.

About & evidence

What this tool is for, what it rests on, and how to report a problem.

Evidence and limits

Read this once before relying on any number here.
Who it is for
ICU/CCU doctors, pharmacists and nurses who already know these drugs and scores and want quick arithmetic at the bedside: infusion rates, renal dose bands, ventilator targets, acid–base workup, electrolyte corrections and common scores.
What it does not do
Choose a drug or a dose for a patient, replace a pharmacy check, know your unit’s drug concentrations, or apply every renal or hepatic adjustment.
Methods and evidence
Each calculator applies a published formula or score as written (Cockcroft–Gault, Winters, Berlin, ARDSnet, SOFA, RASS and others). Dose ranges come from standard ICU references and guidelines. Where a calculator has a source, it is printed under the result; the full list is under Clinical references.
Validation and known limitations
  • Not prospectively or independently validated, and the code and dose tables have not been externally audited.
  • Decision support only. It does not replace clinical judgement, local protocols or the drug label.
  • Default concentrations are common preparations, not necessarily yours. If your bag differs, the mL/hr is wrong.
  • Cockcroft–Gault is unreliable when creatinine is changing, at extremes of body weight and in augmented renal clearance.
  • Some results have no individual citation yet: MAP, shock index, CPP, anion gap, A–a gradient, corrected Ca and Na, osmolality, K⁺ replacement, maintenance fluids, GCS, qSOFA, RSI, antidotes and neuroprotection.
  • Not a regulated medical device.
Version
1.5.9 · last reviewed 05 November 2026.
Report a suspected error
Say what you entered, what the app showed and what you expected, with a source if you have one. Leave out patient identifiers.
Report an error · contact@thetract.org

Designed by

Author & clinical lead
NameDr. Mohamed Najm
CredentialsMBBS · PgDip EM · FEBN · MRCEM SECONDARY
RoleNeurology & Neurocritical Care
AffiliationKMGH / King Fahad Medical City, Saudi Arabia
Why this appBuilt after one shift too many spent flipping between five different apps at a shock patient's bedside.
Phone / WhatsApp+966 56 476 2990
Websitethetract.org
LinkedInlinkedin.com/in/mohamed-najm
GitHub@mahham20022-art
Version1.5.9
Last reviewed05 Nov 2026

📧 Contact Us

Questions, feature requests, or clinical corrections — send a note.
contact@thetract.org

Data on this device

What is stored
One unencrypted browser storage entry (localStorage, key najmICU_v2) holding, for each patient pill, its label, patient bar (weight, height, age, sex, creatinine), values typed into calculators, score selections and shift notes; plus and display settings (units, last tab, search filters, whether you have seen the welcome screen). The offline cache holds only the app’s own files.
What leaves the device
Nothing you enter, unless you choose to send it. Smart Assistant sends a prompt only when you press “Open in Claude” or “Open in ChatGPT”, and shift notes go with it only if you tick the box. Separately, page views are counted with GoatCounter: no cookies and none of your entries, and it is skipped if your browser sends Do Not Track.
Shared computers
Anyone using this browser profile can read what is saved. Don’t enter names, MRNs or dates of birth. On a shared device, keep pill labels neutral (P1, P2) rather than bed numbers, and clear the data at the end of your shift.

Install and offline use

iPhone or iPad (Safari)
Tap Share, then “Add to Home Screen”.
Android (Chrome)
Open the ⋮ menu, then “Install app” (or “Add to Home screen”).
Desktop (Chrome or Edge)
Use the install icon at the right of the address bar.
Offline
After one online visit, all calculators, scores, references and the notes pad work without a connection. Updates load the next time you open the app online.
Needs a connection
  • Smart Assistant’s “Open in Claude” and “Open in ChatGPT” (they open claude.ai or chatgpt.com).
  • The Source link (GitHub) and email links (your mail app).
  • The page-view count, which is simply skipped offline.

Clinical References

Sources for dose ranges, formulas, and score interpretations.

Changelog

1.5.9 · 05 November 2026

  • Custom domain — Najm ICUCalc now lives at https://icucalc.thetract.org/. CNAME file + sitemap.xml + robots.txt + canonical + Open Graph all point at the new domain. Old github.io URL continues to work via Pages redirect.
  • About card: added LinkedIn + GitHub rows.
  • Formula audit: 17 core calculators verified against published worked examples (CrCl, MAP, QTc Bazett, AG, osmolal gap, P/F, corrected Ca, driving pressure, ROX, MELD-Na, Parkland, Devine IBW, Mosteller BSA, RSBI, Mifflin REE).

1.5.8 · 05 November 2026

  • Per-card source citations — every formula now shows its reference under the card itself, not only in the Clinical References list. Added: Bazett / Fridericia / Framingham (QTc), Allgöwer & Buri + Liu 2012 (shock index), Brain Trauma Foundation 2017 (CPP), Payne 1973 (corrected Ca), Katz 1973 + Hillier 1999 (corrected Na), Kraft 2005 (K⁺ replacement), Holliday & Segar 1957 (4-2-1 maintenance), Teasdale & Jennett 1974 (GCS card), Singer Sepsis-3 2016 (qSOFA card).
  • About card: added Role (Neurology & Neurocritical Care), Affiliation (KMGH / KFMC), Website link (thetract.org), and a one-line "Why this app".

1.5.7 · 01 November 2026

  • New protocol: ABCDEF ICU Liberation Bundle red-themed card in Neuroprotection — Assess pain (CPOT/NRS), Both SAT + SBT, Choice of light sedation (RASS 0 to − 2, prefer non-benzos), Delirium (CAM-ICU + DELIRIUMS mnemonic), Early mobility, Family engagement.
  • New calculator: Weaning Readiness + RSBI in Ventilator tab — SBT eligibility, pass criteria, cuff-leak test, post-extubation HFNC/NIV guidance.
  • New card: Transfusion Thresholds in Renal & Fluids — Hb / platelet / FFP / cryo / PCC triggers with expected rise, plus TRALI vs TACO comparison table (onset, mechanism, BP, BNP, LV, treatment).
  • New calculator: Nutrition Targets in Renal & Fluids — Mifflin-St Jeor REE × stress factor, protein 1.2 – 2.0 g/kg, refeeding risk and tips (EDEN, TARGET, EPaNIC).
  • References: added Yang & Tobin 1991 (RSBI), Thille HFNC 2019, PADIS 2018, ICU Liberation (Pun 2019), ABC trial 2008, Schweickert 2009, MIND-USA 2018, TRICC 1999, TRISS 2014, AABB 2016, ISBT TRALI 2019, ASPEN/SCCM 2016, EDEN 2012, TARGET 2018.

1.5.6 · 05 November 2026

  • New protocol: ARDS Management Bundle red-themed card in Ventilator tab — Berlin severity, lung-protective ventilation (TV 6/PBW, Pplat ≤ 30, DP < 15, permissive hypercapnia pH ≥ 7.20), ARDSnet lower PEEP/FiO₂ ladder, PROSEVA prone criteria (P/F < 150, 16 h/day), ACURASYS/ROSE neuromuscular blockade, FACTT conservative fluid, DEXA-ARDS/RECOVERY steroids, rescue therapies (recruitment, iNO), EOLIA ECMO criteria, SBT/weaning.
  • New score: Murray Lung Injury Score — 4-item (CXR, P/F, PEEP, compliance); average > 2.5 = ECMO criterion.
  • References: added Murray 1988, Guérin PROSEVA NEJM 2013, Papazian ACURASYS NEJM 2010, PETAL ROSE NEJM 2019, Wiedemann FACTT NEJM 2006, Villar DEXA-ARDS Lancet Resp Med 2020, Combes EOLIA NEJM 2018, Amato NEJM 2015.

1.5.5 · 05 November 2026

  • Tier-2 clinical additions — seven new scores and three new calculators:
  • New scores: NIHSS (11-item, 0–42) · Hunt & Hess (SAH clinical grade 1–5) · Modified Fisher (SAH CT, vasospasm risk) · Child-Pugh (A/B/C, 1-yr survival) · CAM-ICU (delirium screen) · Padua VTE (prophylaxis trigger ≥ 4).
  • New calculators: MELD-Na (UNOS 2016 formula, 90-day mortality bands) · Vancomycin AUC₂₄ bedside estimate (ASHP/IDSA 2020 target 400–600 mg·h/L) · Parkland burns formula (4 mL·kg·%TBSA LR split 8 h/16 h, Rule of Nines).
  • New protocol: Status Epilepticus red-themed card in Neuroprotection — timed escalation (0–5 min stabilisation → 5–20 benzos → 20–40 min 2nd-line → 40–60 min anaesthetic infusion → super-refractory adjuncts).
  • References: added Brott 1989 (NIHSS), Hunt & Hess 1968, Frontera 2006 (mod Fisher), Pugh 1973, Kim 2008 (MELD-Na), Ely 2001 (CAM-ICU), Barbar 2010 (Padua), Glauser 2016 + Kapur ESETT 2019 + Silbergleit RAMPART 2012 (status epilepticus), Baxter & Shires 1968 (Parkland), ABA 2016 (burn transfer).

1.5.4 · 05 November 2026

  • Osmolal gap card rebuilt: severity bands (normal / mild / moderate / severe), parallel calc with and without ethanol, toxic-alcohol differential diagnosis (methanol, ethylene glycol, isopropyl, propylene glycol, mannitol) with escalation plan (fomepizole + HD trigger).
  • References: added Krasowski 2012 (osmolal gap performance), Kraut & Mullins NEJM 2018 (toxic alcohols), Purssell 2001 (ethanol correction).

1.5.3 · 30 October 2026

  • Added author's phone / WhatsApp (+966 56 476 2990) to the About card.
  • Version and last-reviewed date brought up to date across the app.

1.5.1 · 05 November 2026

  • References expanded to 11 sections and 57 citations (Sepsis, ARDS, Trauma/MT, Scores, Formulas, Antibiotics, Toxicology, Hyperkalaemia/DKA, Neuroprotection, Nephrology, general ICU).
  • Clinical references now rendered with cyan section headings for easier scanning.

1.5.0 · 05 November 2026

  • Tier-1 batch for daily ICU/ED use:
  • HEART Score (6-week MACE for undifferentiated chest pain).
  • TIMI (UA/NSTEMI) for 14-day death/MI/urgent-revasc risk.
  • CURB-65 for pneumonia severity triage (outpatient / ward / ICU).
  • ICH Score for 30-day mortality in spontaneous intracerebral haemorrhage.
  • QTc calculator (Bazett + Fridericia + Framingham) in Hemodynamics, with torsades warning ≥ 500 ms.
  • ROX Index in Ventilator for HFNC success prediction (4.88 / 3.85 cut-offs).
  • Hyperkalaemia Emergency Protocol — 4-step pathway (stabilise · shift · remove · monitor).
  • DKA / HHS Protocol — fluids → insulin → K replacement → bicarb thresholds → resolution.
  • Massive Transfusion Protocol — 1:1:1 ratio, TXA, lethal-triad fixes, target values.

1.4.3 · 05 November 2026

  • APACHE II score added to Scores with mortality band interpretation.
  • Sepsis & Septic Shock tab added — full Surviving Sepsis Campaign 2021 bundle (Hour-1, fluids, pressor ladder, empiric abx, source control, steroids, vent, glucose, transfusion, RRT, nutrition, prophylaxis, procalcitonin, when-to-call).

1.4.2 · 25 October 2026

  • Modified Duke Criteria for infective endocarditis — categorical interpretation (Definite / Possible / Rejected).
  • tallyScore() now passes raw selections to score interpreters so categorical scoring works alongside simple sums.

1.4.1 · 9 October 2026

  • Patient pills are now real, keyboard-reachable buttons (switch, rename, remove), with screen-reader labels.
  • “Clear” in the patient bar now clears the active patient’s calculator inputs and scores as well, so a new patient in the same slot never inherits old values.
  • Rename asks for a short label and warns against names and MRNs; the data notice now covers multiple patients.
  • Version shown consistently everywhere.

1.4.0 · 9 October 2026

  • Patient switcher: P1, P2, P3…, each with its own patient bar, inputs, scores and notes; pills can be renamed.

1.3.1 · 9 October 2026

  • Evidence and limits panel on the welcome screen and under About & evidence.
  • Source line under each calculator that has a published reference.
  • Install, offline and stored-data notes; “Clear saved data” moved beside them.
  • Page-view counter now skipped under Do Not Track; privacy policy corrected to disclose it.
  • “Intelligent assistant” wording removed.

1.3.0 · 9 October 2026

  • Shift notes no longer attached to AI links by default; opt-in with a no-identifiers check.
  • “What leaves this device” note in Smart Assistant.
  • Unsupported claims (“precise”, “latest guidelines”) removed.
  • Google Fonts dropped; contact email unified to contact@thetract.org.

1.2.0 · 28–29 July 2026

  • Rocuronium and cisatracurium infusions, Neuroprotective Strategy tab, contact block.
  • Production service worker; manifest paths made relative.

1.1.0 · 28 July 2026

  • High-contrast inputs and missing-input hints; eight more neuromuscular blockers.
  • RSI moved to its own tab with the 7 P’s; creatinine input width fixed.

Disclaimer

Reference aid — not a medical device.
All doses, calculations, and interpretations are for clinical reference only. Every value must be independently verified by a qualified clinician against institutional protocols, drug labels, and the patient's clinical context. The author assumes no liability for clinical decisions made with this tool.
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