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Attachment F <br /> COWS Clinical Opiate Withdrawal Scale <br /> Rest!nQ Pulse Rate Measured after patient is GI Upset over last 112 hour <br /> sitting or lying for one minute <br /> 0 No GI symptoms <br /> 0 80 or less 1 Stomach cramps <br /> 1 81-100 2 Nausea or loose stool <br /> 2 101-120 3 Vomiting or diarrhea <br /> 4 Greater than 120 5 Multiple episodes of diarrhea or vomiting <br /> Sweating over last 112 hour not accounted for by Tremor observation of outstretched hands <br /> room temperature or patient activity <br /> 0 No tremor <br /> 0 No reports of chills or flushing 1 Tremor can be felt, but not observed <br /> 1 Subjective report of chills or flushing 2 Slight tremor observable <br /> 2 Flushed or observable moistness on face 4 Gross tremor or muscle twitching <br /> 3 Beads of Sweat on brow or face <br /> 4 Sweat streaming off face <br /> Restlessness observation during assessment Yawning observation during assessment <br /> 0 Able to sit still 0 No yawning • <br /> 1 Reports difficulty sitting still,but is able to do so 1 Yawning once or twice during assessment <br /> 3 Frequent shifting or extraneous movements of legs/arms 2 Yawning three or more times during assessment <br /> 5 linable to sit still for more than a few seconds 4 Yawning several times/minute <br /> Pupil Size Anxiety or Irritability <br /> 0 Pupils pinned or normal size for room light 0 None <br /> 1 Pupils possible larger than normal for room light 1 Patient reports increasing irritability or anxiousness <br /> 2 Pupils moderately dilated 2 Patient obviously irritable or anxious ' <br /> 5 Pupils so dilated that only the rim of iris is visible 4 Patient so irritable or anxious that assessment <br /> participation is difficult <br /> Bone or Joint Aches if patient was having pain Runny Nose or Tearing Not accounted for by cold <br /> previously, only the additional component attributed to symptoms or allergies <br /> opiate withdrawal is scored <br /> 0 Not present <br /> 0 Not present 1 Nasal stuffiness or unusually moist eyes <br /> 1 Mild diffuse comfort 2 Nose running or tearing <br /> 2 Patient reports severe diffuse aching of joints/muscles 4 Nose constantly running or tears streaming down cheeks <br /> 4 Patient rubbing joints or muscles,unable to sit still <br /> because of discomfort <br /> Gooseflesh Skin Total Score: <br /> 0 Skin is smooth The total score is the sum of all 11 items <br /> 3 Skin piloerection can be felt,or hairs standing up on arms <br /> 5 Prominent piloerection <br /> 21 <br />