Rapid Response Julie Symonds Clinical Lead Angela Cooper

Rapid Response Julie Symonds – Clinical Lead Angela Cooper – Rapid Response Practitioner

S: Mrs A, 96 yrs old. NEWS 10, c/o RR 26, SATS 91%, Temp 38, BP 160/90, pulse 130. DNAR in place. B: Very frail, all care, hoisted. Not eating or drinking, acute onset. Appears settled until any nursing interventions carried out. A: Unsure what problem is but patient is deteriorating. R: Please could you review asap. On arrival: RR 26, SATS 94%, Temp 38⁰C. BP 180/90, pulse 130, BGL 7. 9. Fully conscious. NEWS 8. Bilateral basal crackles with reduced air entry. Unable to cough up secretions. NH have been using suction in her mouth to assist. Diagnosis: Chest Infection. Plan: • i. STAT bloods to check renal function and lactate • Cannulate for trial 24 hrs IVAB • Saline nebs and chest physio • Nursing home to monitor using NEWS and criteria given for call back/escalation plan Outcome: Much improved, Discharged on day 3 with oral antibiotics.

S: Mr B, 93 yrs, NEWS 3 c/o RR 21, SATS 95% on air. DNAR in place B: Recent discharge from acute trust following asp pneumonia, gastric blood and vomiting. Requires all care, hoisted and always leans to left side. A: Don’t know what problem is but concerned as ‘not himself ’ R: Would like a review of patient. On arrival: rr 16, SATS 95% on air, temp 36, BP 122/48, pulse 72. BGL 5. 6. NEWS 2 Crackles evident to Left base with reduced air entry bilaterally. Diagnosis: LRTI Plan: • Bloods to check inflammatory markers. If raised for 24 hrs IVAB, if no improvement for palliative care. Daughter present and in agreement with plan. • Saline nebs and chest physio Outcome: IVAB not indicated, general deterioration over 24 hrs. Eo. L care commenced, anticipatory meds prescribed and discharged back to care of GP and DNs.