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DOCTOR! HELP! MY PATIENT IS A NEWS OF 9! Dr Rebecca RileyANSWERING THE BLEEP Before springing to action, what questions might you ask while taking the bleep call?ANSWERING THE BLEEP Before springing to action, what questions might you ask while taking the bleep call? Who and where? What were they admitted with? What was their NEWS before this? What are they scoring for? Ask for interventions!What are they scoring for? A key question to help you triage the bleep Sats of 95% on 2L Hr 94, BP 109/60 Confusion and temp 38.1 Versus RR of 22 92% on RA HR 125 BP 89/40 Asking for interventions What can the nursing team do in advance of your arrival? Asking for interventions What can the nursing team do in advance of your arrival? Utilise Back PRNs Give Paracetmol To Bed Adjust Send Get an O2 bloods ECG Call a Encourage Fluids SeniorA-E ASSESSMENT AIRWAY BREATHING CIRCULATION OTHER A-E ASSESSMENT AIRWAY BREATHING Is it patent and are they talking? Assess RR and sats Quick GCS TREAT AS YOU MEET If no airway - Immediate Arrest Auscultate - infection? Fluid? call Wheeze? CIRCULATION OTHER HR - regulaChest pain?ady? ECG? BloTempugar BP- High/low? compare to Finish GCS - pupils baseline, intervention? Review Kardex Cap refill Head to Toe - always check the legs INTERVENTION Now you know the issues, what are you going to do to further investigate and treat? INTERVENTION Now you know the issues, what are you going to do to further investigate and treat? Rx Chest Blood: X-ray Cultures VBG Adjust Escalate O2 +/- and ABG informDOCUMENTATION Now you have fixed them what do you write?DOCUMENTATION Now you have fixed them what do you write? Pt details Pt details sticker sticker Date Time Rebecca Riley (F1) ATSP - NEWS 9 RR 22, Sats 92% RA, HR125, BP89/40, temp 38.6DOCUMENTATION Now you have fixed them what do you write? Pt details Pt details sticker sticker Date Time Rebecca Riley (F1) RR 22, Sats 92% RA, HR125, BP89/40, temp 38.6 A - Patent, Pt able to talk, Full sentences B - RR 18 Sats 96% on 2L NS Bilateral Wheeze and bilbasal Creps C- HR 125, BP 98/60 pt in bed with legs elevated Cap refill <2sec D - No pitting oedema, Abdo SNT Glucose 8.2, GCS 15/15DOCUMENTATION Now you have fixed them what do you write? Pt details Pt details sticker sticker Date Time Rebecca Riley (F1) ATSP - NEWS 9 RR 22, Sats 92% RA, HR125, BP89/40, temp 38.6 A - Patent, Pt able to talk, Full sentences Bilateral Wheeze and bilbasal Creps C- HR 125, BP 98/60 pt in bed with legs elevated Cap refill <2sec D - No pitting oedema, Abdo SNT Glucose 8.2, GCS 15/15 NS kindly completed ECG - Sinus tachy @118 - Likely pain driven Pt admitted with Acute Cholecystitis on co-amoxiclav PO.DOCUMENTATION Now you have fixed them what do you write? Pt details Pt details Date sticker sticker Rebecca Riley (F1) Time Rebecca Riley (continued) ATSP - NEWS 9 Pt improving with 2L of O2 RR 22, Sats 92% RA, HR125, BP89/40, Imp: HAP temp 38.6 P A - Patent, Pt able to talk, CXR Full sentences Escalate Abx to Taz B - RR 18 Sats 96% on 2L NS Bloods (CRP, FBC, U+E, Mg, Bone) Bilateral Wheeze and bilbasal Creps Blood cultures Analgesia C- HR 125, BP 98/60 IVF 250ml bolus then 1L maintenance pt in bed with legs elevated Chest physio Cap refill <2sec Salbutamol Nebs D - No pitting oedema, Abdo SNT Glucose 8.2, GCS 15/15 SHO contacted on #1030, happy with current plan NS kindly completed ECG - Sinus tachy Please recontact if further issues @118 - Likely pain driven Rebecca Riley Pt admitteco-amoxiclav PO.lecystitis on #1622DOCUMENTATION Now you have fixed them what do you write? Pt details Pt details Date sticker sticker Rebecca Riley (F1) Time Rebecca Riley (continued) ATSP - NEWS 9 Pt improving with 2L of O2 RR 22, Sats 92% RA, HR125, BP89/40, Imp: HAP temp 38.6 SHO Dr Potter now in attendance SHO contacted on #1030 will attend Agrees with current plan asap P A - Patent, Pt able to talk, CXR Full sentences Escalate Abx to Taz B - RR 18 Sats 96% on 2L NS Bloods (CRP, FBC, U+E, Mg, Bone) Bilateral Wheeze and bilbasal Creps Blood cultures Analgesia C- HR 125, BP 98/60 IVF 250ml bolus then 1L maintenance pt in bed with legs elevated Chest physio Cap refill <2sec Salbutamol Nebs D - No pitting oedema, Abdo SNT Glucose 8.2, GCS 15/15 Please recontact if further issues NS kin@118 - Likely pain driven tachy Rebecca Riley #1622 Pt admitted with Acute Cholecystitis on co-amoxiclav PO. BLEEP TIP OF THE DAY Getting the most out of the original call Get all the patient details, location and the whole story - will save you time in the long run Always ask for a list of jobs - do not accept 'a few wee jobs' Ask for action in advance of your arrival eg. apply 02, get an ECG, send bloods, prepare the catheter trolleyThanks for listening! Questions?