Assessment and Management of acutely unwell patients

1. Assessment andAssessment and
Management of acutelyManagement of acutely
unwell patientsunwell patients
Shibu ChackoShibu Chacko

2. The ‘AT RISK’ patientThe ‘AT RISK’ patient
Certain patients are more likely to developCertain patients are more likely to develop
problems whilst in hospital:problems whilst in hospital:
•Emergency admissionsEmergency admissions
•The elderlyThe elderly
•Patients with chronic conditions -Patients with chronic conditions -
Diabetes, Heart Disease, COPD etcDiabetes, Heart Disease, COPD etc
•Patients who are slow to respond toPatients who are slow to respond to
treatment or develop complicationstreatment or develop complications
•Etc ….Etc ….

3. Systematic Assessment ToolSystematic Assessment Tool
• AA AIRWAYAIRWAY
• BB BREATHINGBREATHING
• CC CIRCULATIONCIRCULATION
• DD DISABILITY & DON’T EVERDISABILITY & DON’T EVER
FORGET A GOODFORGET A GOOD
HANDOVERHANDOVER

4. Assessing the Critically Ill PatientAssessing the Critically Ill Patient
Only progress fromOnly progress from
A to D when eachA to D when each
stage has been completedstage has been completed

5. Airway

6. AirwayAirway

7. Anatomy of AirwayAnatomy of Airway

8. AIRWAYAIRWAY
• OBSTRUCTION OF THE AIRWAY IS ANOBSTRUCTION OF THE AIRWAY IS AN
EMERGENCY!EMERGENCY!
USE THEUSE THE
LOOKLOOK
LISTENLISTEN
FEELFEEL
APPROACHAPPROACH

9. LOOKLOOK
• Is the patient conscious?Is the patient conscious?
USE THE AVPU SYSTEMUSE THE AVPU SYSTEM
A – ALERTA – ALERT
V – responds to VOICEV – responds to VOICE
P – responds to PAINP – responds to PAIN
U – UNRESPONSIVEU – UNRESPONSIVE
TIP – If the patient can answer theTIP – If the patient can answer the
question ‘Are you ok?’, then he is alertquestion ‘Are you ok?’, then he is alert
and his windpipe is not blocked!and his windpipe is not blocked!

10. LISTEN FOR:LISTEN FOR:
• Gurgling – liquid in the mouth or upperGurgling – liquid in the mouth or upper
airwaysairways
• Snoring – tongue is partially blocking theSnoring – tongue is partially blocking the
airwayairway
• Stridor – harsh, high pitched sound heardStridor – harsh, high pitched sound heard
on breathing in, indicating a partialon breathing in, indicating a partial
blockage of the windpipeblockage of the windpipe

11. FEEL FOR:FEEL FOR:
• THE PRESENCE OF AIR BY PLACINGTHE PRESENCE OF AIR BY PLACING
YOUR HAND OR CHEEK IMMEDIATELYYOUR HAND OR CHEEK IMMEDIATELY
IN FRONT OF THE PATIENT’S MOUTHIN FRONT OF THE PATIENT’S MOUTH

12. ANY PROBLEM WITH “A’’
SEEK HELP
IMMEDIATELY
HOW????

13. WHAT DO YOU DO NOW?WHAT DO YOU DO NOW?

14. You might be asked to get:
• Suction Equipment
• Equipments from the Airway
drawer on the resuscitation trolley
• Oxygen masks, tubing etc

15. Airway adjuncts
Nasopharyngeal airway

16. Oropharyngeal (Guedel) Airway

17. Endotracheal tube

18. Breathing

19. BREATHINGBREATHING
Shortness of breath at rest or with minimalShortness of breath at rest or with minimal
exertion is an important sign of seriousexertion is an important sign of serious
illness.illness.
USE THEUSE THE LOOKLOOK
LISTENLISTEN
FEELFEEL
APPROACHAPPROACH

20. LOOKLOOK
• RATE OF BREATHINGRATE OF BREATHING – this is the– this is the
most useful sign that a patient is inmost useful sign that a patient is in
respiratory distressrespiratory distress
• HowHow DEEPLYDEEPLY is the patient breathing?is the patient breathing?
• CYANOSISCYANOSIS – Does the patients lips, skin– Does the patients lips, skin
and/or tongue have a blue, dusky tinge?and/or tongue have a blue, dusky tinge?
• SEE-SAW BREATHINGSEE-SAW BREATHING

21. Cyanosis

22. LISTENLISTEN
• Is the patientIs the patient strugglingstruggling to speak or canto speak or can
only manage short sentences?only manage short sentences?
• Can you hearCan you hear rattlingrattling noises from thenoises from the
chest, caused by fluid in the largechest, caused by fluid in the large
bronchi?bronchi?
• Can you hearCan you hear wheezeswheezes caused bycaused by
constriction of the bronchi seen in asthmaconstriction of the bronchi seen in asthma
or chronic bronchitis?or chronic bronchitis?

23. FEELFEEL
• Place your hands on the patients chest ifPlace your hands on the patients chest if
you suspect that the patients breathing isyou suspect that the patients breathing is
too shallow. You will then feel how muchtoo shallow. You will then feel how much
or how little the chest is moving with everyor how little the chest is moving with every
breath.breath.

24. Do you needDo you need
to call forto call for
help now?help now?
ANY PROBLEM WITH ‘’B’’
SEEK HELP
IMMEDIATELY
TIPTIP – MAKE SURE YOU COUNT THE– MAKE SURE YOU COUNT THE
RESPIRATORY RATE FOR ONE FULL MINUTERESPIRATORY RATE FOR ONE FULL MINUTE
AND GATHER THE EQUIPMENT NEEDED TOAND GATHER THE EQUIPMENT NEEDED TO
APPLY OXYGENAPPLY OXYGEN

25. Oxygen Delivery SystemsOxygen Delivery Systems
Oxygen is a prescription only drugOxygen is a prescription only drug
What does that mean to you ?What does that mean to you ?

26. Nasal CannulaNasal Cannula
0.5 – 4 litres per min0.5 – 4 litres per min

27. Medium Concentration MaskMedium Concentration Mask
Minimum 5 litres per minMinimum 5 litres per min
Uncontrolled system – canUncontrolled system – can
only tell the number ofonly tell the number of
litres the person is havinglitres the person is having

28. Non-rebreathing Mask/BagNon-rebreathing Mask/Bag
15 litres per min15 litres per min
Uncontrolled system – canUncontrolled system – can
only tell the number of litresonly tell the number of litres
the person is havingthe person is having

29. Venturi SystemVenturi System
controlled systemcontrolled system

30. Cold Water HumidificationCold Water Humidification

31. Bag-Valve MaskBag-Valve Mask

32. ANY PROBLEM WITH “B’’ SEEK HELP
IMMEDIATELY
Never put your fingers
into a patients' mouth.
Never try to remove
anything you can see

33. WHAT DO YOU DO NOW?WHAT DO YOU DO NOW?

34. You might be asked to do:
• Sit the patient upright
• Arrange a non-rebreathing mask
• Arrange equipments for an ABG collection
• Prepare necessary equipments for nebulizer
• Pulse oxymeter

36. Circulation

37. CIRCULATIONCIRCULATION
• A compromised circulation means thatA compromised circulation means that
there is not enough blood travelling to thethere is not enough blood travelling to the
major organs of the bodymajor organs of the body
• This is CLINICAL ‘SHOCK’ and may beThis is CLINICAL ‘SHOCK’ and may be
due to fluid loss through bleeding, burnsdue to fluid loss through bleeding, burns
or chronic diarrhoea.or chronic diarrhoea.

38. CIRCULATIONCIRCULATION
USE THEUSE THE LOOKLOOK
LISTENLISTEN
FEELFEEL
APPROACHAPPROACH

39. LOOK
Look for aLook for a drop in blood pressuredrop in blood pressure and aand a
rise in the pulse raterise in the pulse rate
Causes:Causes:
• DehydrationDehydration
• Loss of fluid- Bleeding, Diarrhoea, VomitingLoss of fluid- Bleeding, Diarrhoea, Vomiting
Sweating, High output stoma, drainsSweating, High output stoma, drains
• Need for more fluid – SepsisNeed for more fluid – Sepsis
• A weak heart muscleA weak heart muscle

40. LOOKLOOK
• Is the patient passing urine? – a low urine
output is a late sign of shock and suggests
that the patient's kidneys are not getting
enough blood through
Normal urine output?????
• Look for excessive drainage from
wounds or drains
• Look at the patient's conscious level

41. LISTENLISTEN
• Listen to the patient – is he or she complainingListen to the patient – is he or she complaining
of heaviness or tightness in the chest?of heaviness or tightness in the chest?
This could be due to a variety of reasons -:This could be due to a variety of reasons -:
• ASTHMAASTHMA
• HIATUS HERNIAHIATUS HERNIA
• ANGINAANGINA
• HEART ATTACK - How to diagnose??HEART ATTACK - How to diagnose??

42. FEELFEEL
• Does the patient have cool, pale
limbs and digits?
• Peripheral pulses – how easily is it to
feel and measure the patient’s radial
pulse?

43. ANY PROBLEM WITH ‘’C’’ SEEK
HELP IMMEDIATELY
Do you needDo you need
to call forto call for
help now?help now?
TIPTIP – If you suspect that a patients’ circulatory– If you suspect that a patients’ circulatory
system may be depleted, alert a trained member ofsystem may be depleted, alert a trained member of
staff ASAP, and prepare thestaff ASAP, and prepare the patient for fluids andfor fluids and
blood tests. The patient may also need an ECG.blood tests. The patient may also need an ECG.

44. WHAT DO YOU DO NOW?WHAT DO YOU DO NOW?

45. You might be asked:
• GET HELP
• Get ECG
• Oxygen
• Cardiac MONITOR
• Assist with IV Access
• Bloods

47. DisabilityDisability // Altered Conscious LevelAltered Conscious Level
• What is your patients AVPU / GCSWhat is your patients AVPU / GCS
A – AlertA – Alert
V – Responds to voiceV – Responds to voice
P – Responds to painP – Responds to pain
U – UnresponsiveU – Unresponsive
• PAIN SCOREPAIN SCORE
• BLOOD GLUCOSE – Always do a BM on aBLOOD GLUCOSE – Always do a BM on a
patient with altered level of consciousnesspatient with altered level of consciousness

48. Recovery position

49. Low blood sugar

50. Causes of Low BM
• Too much insulin
• Too much oral medication
• Not enough food- smaller hospital portions
• Delayed or missed meals
• Hot weather
• Improving mobility / Exercising in Gym

51. HypoglycaemiaHypoglycaemia Sign & SymptomsSign & Symptoms
Blood Glucose levels <4.0mmolsBlood Glucose levels <4.0mmols
• SweatingSweating
• DizzyDizzy
• HungerHunger
• HeadacheHeadache
• Tingling around the mouth / lipsTingling around the mouth / lips
• AgitationAgitation
• Loss of consciousnessLoss of consciousness

52. TreatmentTreatment (Trust policy)(Trust policy)
Tell a Registered Nurse then:Tell a Registered Nurse then:
If the patient is alert and able to swallowIf the patient is alert and able to swallow
• 4 teaspoons of sugar (dissolved in 100ml4 teaspoons of sugar (dissolved in 100ml
of warm water)of warm water)
• 100ml of Lucozade100ml of Lucozade
• Small can of ordinary CokeSmall can of ordinary Coke
• Small carton of pure fruit juiceSmall carton of pure fruit juice

53. Recheck
The blood glucose after 5-15 mins
If the blood glucose is <4.0, repeat the
treatment
If the BM still low after third treatment –
Urgent Medical help needed

54. Severe Hypoglycemia
The patient will
• Have a BM <3.0
• Reduced Level of consciousness
• Unable to tolerate orally
This must be treated as Medical
emergency….make a cardiac arrest call
and follow the ABCDE assessments

55. DDon’ton’t EEverver FForgetorget GGoodood HHandoverandover
ALWAYS ASKALWAYS ASK YOURSELFYOURSELF ::
Is the important informationIs the important information
available to the people thatavailable to the people that
need it?need it?

56. Importance of Good
documentation
• Not able to remember all the observations
• Not able to remember all the activities
• Not with the patient all the time – so as a
communication tool
• Legal importance
Remember:
If not documented, didn’t happen

57. ALWAYS CHECK FORALWAYS CHECK FOR TWOTWO
THINGSTHINGS
Have you reported anything that isHave you reported anything that is
worrying you about your patient to theworrying you about your patient to the
nurse or doctor responsible for thenurse or doctor responsible for the
patient?patient?
TIP –:TIP –: Try to use the ABC system when youTry to use the ABC system when you
hand over…………….this will help you tohand over…………….this will help you to
remember all important detailsremember all important details

58. ALWAYS CHECK FORALWAYS CHECK FOR TWOTWO
THINGSTHINGS
Have you recorded and documented ALLHave you recorded and documented ALL
the patients observations?the patients observations?
TIP: Deterioration is often gradual – in orderTIP: Deterioration is often gradual – in order
to spot a decline in the patientsto spot a decline in the patients
condition, it is important to documentcondition, it is important to document
every set of observations.every set of observations.

59. WHAT DO YOU DO NOW?WHAT DO YOU DO NOW?

60. SBAR

61. What is SBAR?
SBAR is a structured method for communicating
critical information that requires immediate
attention and action
SBAR improve communication, effective
escalation and increased safety
SBAR has 4 steps
Situation
Background
Assessment
Recommendation

62. What it is not
It is not to be used to call for emergency
assistance e.g.
unconscious patient
Cardiac arrest
Any other medical emergency
You then must call 2222

63. Why use SBAR?
To reduce the barrier to effective communication
across different disciplines and levels of staff.
SBAR creates a shared mental model around all
patient handoffs and situations requiring escalation, or
critical exchange of information (handovers)
SBAR is memory prompt; easy to remember and
encourages prior preparation for communication
SBAR reduces the incidence of missed
communications

64. How can SBAR help me?
Easy to remember
Clarifies what information needs
communicating quickly
Points to action
Prevents “hinting and
hoping”

65. Uses & Settings
for SBAR
Inpatient or outpatient / Urgent or non urgent communications
Conversations with a physician, either in person or over the
phone
- Particularly useful in nurse to doctor communications
- Also helpful in doctor to doctor consultation
Discussions with allied health professionals
- e.g. Respiratory therapy
- e.g. Physiotherapy
Conversations with peers - e.g. Change of shift report
Escalating a concern
Handover from an ambulance crew to hospital staff

66. © NHS Institute for Innovation and Improvement Safer Care
Situation
Identify yourself the site/unit you are calling from
Identify the patient by name and the reason for your
report
Describe your concern
Firstly, describe the specific situation about which you
are calling, including the patient's name, consultant,
patient location, resuscitation status, and physiological
observations (MMEWS).
For example:
"This is Lou, a registered nurse on Nightingale Ward. The reason I'm calling is that
Mrs Taylor in room 25 has become suddenly short of breath, her oxygen saturation
has dropped to 88 per cent on room air, her respiration rate is 24 per minute, her
heart rate is 110 and her blood pressure is 85/50.”

67. Background
Give the patient's reason for admission
Explain significant medical history
Overview of the patient's background: admitting
diagnosis, date of admission, prior procedures, current
medications, allergies, pertinent laboratory results and
other relevant diagnostic results. For this, you need to
have collected information from the patient's chart,
flow sheets and progress notes.
For example:
"Mrs. Taylor is a 69-year-old woman who was admitted from home three
days ago with a community acquired chest infection. She has been on
intravenous antibiotics and appeared, until now, to be doing well. She is
normally fit and well and independent.”

68. Assessment
Physiological observations (MMEWS)
Clinical impressions, concerns
For example:
You need to think critically when informing the doctor /
nurse/ other health care professional of your
assessment of the situation. This means that you have
considered what might be the underlying reason for
your patient's condition.
If you do not have an assessment, you may say:
"Mrs. Taylor’s observations have been stable from admission but deteriorated
suddenly. She is also complaining of chest pain and there appears to be blood in her
sputum. She has not been receiving any Fragmin.”
“I’m not sure what the problem is, but I am worried.”

69. Recommendation
Explain what you need - be specific about request and
time frame
Make suggestions
Clarify expectations
Finally, what is your recommendation? That is, what
would you like to happen by the end of the
conversation with the person? Any order that is given
on the phone needs to be repeated back to ensure
accuracy.
"Would you like me get a stat CXR? and ABGs? Start an IV? I would
like you to come immediately”

70. SBAR Summary
Incorporating SBAR may seem simple, but it takes
considerable training.
It can be very difficult to change the way people
communicate, particularly with senior staff.
But together we can make for better Patient Safety and
overall improve communication
When you make an SBAR call tell the caller “this is an
SBAR call” as it should help focus them

71. Some case studies

72. Airway Case StudyAirway Case Study
Mrs Jones is a 60 yr old lady who wasMrs Jones is a 60 yr old lady who was
admitted to the ward 14 days ago followingadmitted to the ward 14 days ago following
a CVA (stroke). Since admission she hasa CVA (stroke). Since admission she has
made some progress and has begun tomade some progress and has begun to
regain movement in her limbs. She is stillregain movement in her limbs. She is still
receiving speech therapy and physiotherapyreceiving speech therapy and physiotherapy
in the rehab' ward.in the rehab' ward.

73. • It is 17.30 and you are collecting the teaIt is 17.30 and you are collecting the tea
trays from the patients’ beds when youtrays from the patients’ beds when you
come across Mrs Jones who is slumped income across Mrs Jones who is slumped in
her bed and has hardly touched herher bed and has hardly touched her
sandwiches. She appears to be sleepingsandwiches. She appears to be sleeping
as she’s snoring loudly. This is unusual,as she’s snoring loudly. This is unusual,
as she normally enjoys her food andas she normally enjoys her food and
usually asks for more.usually asks for more.

74. Tell us what you are to do?

75. Breathing case study

76. Breathing Case StudyBreathing Case Study
Mr Williams is a 58 yr old farmer who usedMr Williams is a 58 yr old farmer who used
to smoke heavily. He is admitted to hospitalto smoke heavily. He is admitted to hospital
after having a ‘cold’ for nearly two weeks.after having a ‘cold’ for nearly two weeks.
He is coughing up green sputum. OnHe is coughing up green sputum. On
admission he looks healthy as he has aadmission he looks healthy as he has a
ruddy tanned complexion. However, he isruddy tanned complexion. However, he is
having difficulty in speaking and complainshaving difficulty in speaking and complains
of discomfort in his chest.of discomfort in his chest.

77. AdmissionAdmission
AVPUAVPU ALERTALERT
Respiratory rateRespiratory rate 24b/m24b/m
SaturationsSaturations 92%92%
Blood pressureBlood pressure 160/80160/80
Pulse RatePulse Rate 102 bpm102 bpm
TemperatureTemperature 38.538.5
Day 2
ALERTALERT
unrecordedunrecorded
91%91%
110/50110/50
115 bpm115 bpm
39.439.4
His observations

78. You are on a late shift and are asked to lookYou are on a late shift and are asked to look
after Mr Williams’ bay. Your first task is to recordafter Mr Williams’ bay. Your first task is to record
his observations. When you approach him andhis observations. When you approach him and
inform him of your intentions, you notice that heinform him of your intentions, you notice that he
is receiving oxygen via a Venturi-mask at 24%.is receiving oxygen via a Venturi-mask at 24%.
When you speak to him, he manages to answerWhen you speak to him, he manages to answer
but his breathing is very fast and shallow.but his breathing is very fast and shallow.
Having said that, he looks well and tannedHaving said that, he looks well and tanned

79. Tell us what you are to do?

80. Mr Williams’ observations -:Mr Williams’ observations -:
• Level of ConsciousnessLevel of Consciousness AGITATEDAGITATED
• Resp rateResp rate 34b/m34b/m
• SatsSats 89%89%
• Blood PressureBlood Pressure
100/40100/40 mmHGmmHG
• Pulse RatePulse Rate 130 p/m130 p/m
• TemperatureTemperature 35.235.2

81. Cardiovascular case study

82. Circulation Case StudyCirculation Case Study
Mrs Thomas is a 66yrs old lady routinelyMrs Thomas is a 66yrs old lady routinely
admitted to hospital for a hysterectomy andadmitted to hospital for a hysterectomy and
otherwise in good health. Two hours postotherwise in good health. Two hours post
op, Mrs Thomas is back on the ward. Sheop, Mrs Thomas is back on the ward. She
has a drain and catheter in situ and has anhas a drain and catheter in situ and has an
IV pump to control her pain. She also has aIV pump to control her pain. She also has a
drip with a litre bag of saline running over 12drip with a litre bag of saline running over 12
hrshrs

83. Mrs Thomas’ observations -:Mrs Thomas’ observations -:
• Level of ConsciousnessLevel of Consciousness ALERTALERT
• Resp rateResp rate 16b/m16b/m
• SatsSats 98%98%
• Blood PressureBlood Pressure 140/85140/85
mmHGmmHG
• Pulse RatePulse Rate 80 p/m80 p/m
• TemperatureTemperature 36.736.7

84. Later in the afternoon you go to MrsLater in the afternoon you go to Mrs
Thomas to offer her a wash and check herThomas to offer her a wash and check her
observations. You notice that she is veryobservations. You notice that she is very
pale and drowsy but rousable, her oxygenpale and drowsy but rousable, her oxygen
mask is off her face and she complainsmask is off her face and she complains
that it is uncomfortable.that it is uncomfortable.

85. Mrs Thomas’ observationsMrs Thomas’ observations
• Level of ConsciousnessLevel of Consciousness responding toresponding to VOICEVOICE
• Resp rateResp rate 28b/m28b/m
• SatsSats 92%92%
• Blood PressureBlood Pressure 90/5090/50
mmHGmmHG
• Pulse RatePulse Rate 120 p/m120 p/m
• TemperatureTemperature 37.037.0

86. • Mr Frank is a 42 yr old businessman whoMr Frank is a 42 yr old businessman who
was an emergency admission two dayswas an emergency admission two days
ago with epigastric pain. He smokes 19ago with epigastric pain. He smokes 19
cigarettes a day. He has been pain freecigarettes a day. He has been pain free
since admission and is awaiting furthersince admission and is awaiting further
investigationsinvestigations

87. • It is 12.30 and Mr Frank states that he is feelingIt is 12.30 and Mr Frank states that he is feeling
unwell and has indigestion. He looks pale. Youunwell and has indigestion. He looks pale. You
record his observationsrecord his observations
Level of ConsciousnessLevel of Consciousness ALERTALERT
Resp RateResp Rate 18 p/m18 p/m
SaturationsSaturations 95% on air95% on air
BPBP 130/60 mmHg130/60 mmHg
Pulse ratePulse rate 80b/m80b/m
TemperatureTemperature 36.536.5

88. Handover case study

89. Case StudyCase Study (Good Handover)(Good Handover)
Mrs Davies is a 48yrs old lady who has returnedMrs Davies is a 48yrs old lady who has returned
from a recent holiday in Spain with pneumonia.from a recent holiday in Spain with pneumonia.
She is admitted to hospital for treatment with IVShe is admitted to hospital for treatment with IV
antibiotics. Her admission observations areantibiotics. Her admission observations are
Level of ConsciousnessLevel of Consciousness ALERTALERT
Resp RateResp Rate 23b/m23b/m
SaturationsSaturations 92% on air92% on air
BPBP 130/60130/60
Pulse ratePulse rate 92b/m92b/m
TemperatureTemperature 38.438.4

90. Mrs Davies’ ProblemMrs Davies’ Problem
It’s 18.30 hrs, it’s been a very busy dayIt’s 18.30 hrs, it’s been a very busy day
and there is still plenty to do before theand there is still plenty to do before the
end of the shift. Mrs D is in bed but herend of the shift. Mrs D is in bed but her
venflon has ‘tissued’. You are doing somevenflon has ‘tissued’. You are doing some
routine observationsroutine observations
Level of ConsciousnessLevel of Consciousness ALERTALERT
Resp RateResp Rate unrecordedunrecorded
SaturationsSaturations 92% on 60% oxygen92% on 60% oxygen
BPBP 95/45 mmHg95/45 mmHg
Pulse ratePulse rate 102b/m102b/m
TemperatureTemperature 38.038.0

91. • During the night shift at 5 am, Mrs DaviesDuring the night shift at 5 am, Mrs Davies
becomes more unwell. Her obs are-:becomes more unwell. Her obs are-:
Level of ConsciousnessLevel of Consciousness DrowsyDrowsy
Resp RateResp Rate 38 p/m38 p/m
SaturationsSaturations 85% on 100% oxygen85% on 100% oxygen
BPBP 86/40 mmHg86/40 mmHg
Pulse ratePulse rate 116b/m116b/m
TemperatureTemperature 38.838.8

92. Using SBAR tell us how you
are going to get help

93. • A doctor is called, and a chest x ray isA doctor is called, and a chest x ray is
ordered which shows a worseningordered which shows a worsening
pneumonia. A new drip is sited, rapidpneumonia. A new drip is sited, rapid
fluids are given and the antibiotics arefluids are given and the antibiotics are
changed. The on-call physiotherapist ischanged. The on-call physiotherapist is
asked to treat Mrs Davies however she isasked to treat Mrs Davies however she is
too drowsy to comply. Critical care istoo drowsy to comply. Critical care is
informed and arrangements are made forinformed and arrangements are made for
transfer.transfer.

94. Summary

95. SUMMARY – What have you learntSUMMARY – What have you learnt
on the BEACH?on the BEACH?
• BE ALERT and BE SYSTEMATICBE ALERT and BE SYSTEMATIC
• NEVER BE AFRAID TO CALL FOR HELPNEVER BE AFRAID TO CALL FOR HELP
When assessing a patient always follow the sameWhen assessing a patient always follow the same
system……system……
A - airwayA - airway
B - breathingB - breathing
C - circulationC - circulation
D – DisabilityD – Disability
DON’T EVER FORGETDON’T EVER FORGET
GOOD HANDOVER usingGOOD HANDOVER using SBARSBAR

96. THANK YOUTHANK YOU