Clinical Opiate Withdrawal Scale

COWS · SCORE TOOL

COWS Assessment

Score opioid withdrawal symptoms; the total updates live as you select each score.

This tool supports clinical assessment only. Follow your organisation's protocol and escalate urgent symptoms immediately.

Resting heart rate

Measure resting pulse (beats/min).

Score 0–5

Sweating

Observation.

Score 0–4

Restlessness

Observation.

Score 0–5

Pupil size

Measure pupil diameter (mm).

Score 0–5

Bone / joint aches

Ask about aches; observation.

Score 0–4

Runny nose / tearing

Observation.

Score 0–4

GI upset

Ask about nausea, cramps, diarrhoea.

Score 0–5

Tremor

Arms extended; observation.

Score 0–4

Yawning

Observation.

Score 0–4

Anxiety / irritability

Ask / observation.

Score 0–4

Gooseflesh skin

Observation (touch skin).

Score 0–5

Current score

Select scores above — your total updates automatically.

Scoring legend

5–12Mild

13–24Moderate

25–36Moderately severe

>36Severe

For reference only — verify against current protocol.

CPR Refresher

Compression : Ventilation

30:2

Regardless of officer numbers

Rate100–120 /min

Depth≥ 5 cm

Hand placement2 hands — lower sternum

CPR if pulse< 40 BPM

Advanced airway6–10 breaths/min (continuous compressions)

ALS Medications

Epinephrine1 mg IV/IO q3–5 min

Amiodarone300 mg IV/IO (refractory VF/VT)

Lidocaine1–1.5 mg/kg IV/IO (alt)

Magnesium1–2 g IV (torsades)

Sodium Bicarb1 mEq/kg IV (hyperK/TCA)

Peds GuideALS PCS v5.4

Enter patient weight (0.5 – 149 kg)

Enter patient weight to calculate doses