Recognising an acutely unwell patient Flashcards
What are the general parameters of an EWS?
- A&B - RR, SpO2, air or oxygen?
- C - systolic blood pressure, pulse
- D - consciousness
- E - temperature
How are EWS scores generally interpreted?
Graded response to monitoring and escalation e.g.
- 0 = obs min every 12hrs
- >7 = continuous monitoring, immediate escalation to medical team, emergency assessment by critical outreach team
Should you always wait for a patient to reach a specific EWS before calling for help?
No - if the patient is clearly deteriorating and their EWS is rising, call for help early
Who can you call for help if you are worried about a patient scoring highly on their EWS?
Cardiac arrest team OR
(in many hospitals, they have been replaced by) the rapid response team/critical care outreach team/medical emergency team
A patient has an EWS of 7 or more. Where should they be managed?
This patient is likely to be critically ill. Critically ill patients should be admitted to a level 2 or 3 clinical care facility e.g. ICU, HDU or resuscitation room. They require continuous monitoring and doctors/nurses experienced in advanced resuscitation and critical care skills.
You are about to see a patient who is suspected to have an acute exacerbation of asthma, when you have been bleeped by a nurse to see a patient who is scoring EWS=5. Your colleagues are all busy seeing patients. How would you approach this situation?
“Before I get to the patient I would gather more information about the patient –I would request the patient’s details (including name, hospital ID, location) and ask if they were worried about the patient, request a fresh set of basic observations (including SaO2, HR, BP, RR, Temp and an ECG) and gather the patient’s notes and drug chart.
I would use this information to determine which patient needs to be seen more urgently. If another patient needed to be seen more urgently I would inform the nurse I would be there as soon as possible–ask the nurse to carry out 15 minute obs and to inform me if sudden deterioration. I would then approach the patient to complete an A-E assessment.
If I was worried that either patient was deteriorating acutely I would alert a senior and call 2222.”
You approach a deteriorating patient and have completed an A-E assessment. What are your next steps?
treatment of immediately life-threatening problems
an early call for help
frequent reassessment to assess effects of interventions
What the most common deranged general observations before a cardiac arrest?
hypoxia
hypotension
