A fictional 67-year-old inpatient becomes newly confused, tachypnoeic and clammy during an evening ward round.
Frame the danger first.
- Treat physiological deterioration as time-critical even before the diagnosis is known.
- Look for an immediate threat at each stage of an ABCDE assessment.
- Reassess after every intervention and follow the trend, not one observation.
Act, escalate, reassess.
- Call for appropriate help early and state clearly that the patient is deteriorating.
- Use an ABCDE assessment, monitoring and investigations appropriate to the clinical setting.
- Review medicines, observations, fluid balance and recent events while parallel tasks continue.
- Use the current local escalation, resuscitation and critical-care referral pathway.
Red flags that change pace.
- Threatened airway, severe respiratory distress or rapidly falling oxygen saturation
- Shock, reduced consciousness, seizure or rapidly worsening physiology
- Clinical concern that exceeds the numerical early-warning score
What makes care less safe.
- Waiting for a complete diagnosis before escalating
- Completing observations without acting on the trend
- Failing to repeat the assessment after an intervention
Say the concern plainly.
Situation: I am with a deteriorating patient. Background: [brief context]. Assessment: the immediate concern is [ABCDE finding and trend]. Recommendation: please attend now; I have started the local emergency pathway and need help with [specific decision].