Makindo Medical Notes

🚨 The Deteriorating Patient requires rapid recognition, structured assessment, and timely escalation. Failure to act early can lead to cardiac arrest, ICU admission, or death — hence the importance of NEWS2, ABCDE, and early senior help.

🔎 Initial Recognition & Assessment

• Early Warning Signs (NEWS2):
  • 📈 Abnormal vitals: HR, BP, RR, SpO₂, Temp.
  • 🧠 Altered mental state (AVPU or GCS).
  • 🚽 Oliguria, 💧 mottled/cyanosed skin.
• ABCDE Primary Survey:
  • 🅰️ Airway: Open? Obstructed? Use head-tilt/chin-lift or airway adjuncts.
  • 🅱️ Breathing: Rate, effort, SpO₂; give O₂ (target 94–98%, 88–92% if COPD).
  • 🅲️ Circulation: HR, BP, cap refill, IV access, fluids if hypotensive.
  • 🅳 Disability: GCS/AVPU, check glucose, pupils, seizures?
  • 🅴 Exposure: Full exam (rash, trauma, sepsis signs), maintain dignity & warmth.

📢 Escalation of Care

• 📞 Call for help: Activate MET/CCOT/2222 early.
• 📋 SBAR: Structured communication = Situation, Background, Assessment, Recommendation.
• 👩‍⚕️ Senior input: Escalate to registrar/consultant early.

💉 Immediate Medical Interventions

• 🅰️ Airway: Reposition, suction, airway adjuncts → consider intubation if failing.
• 🅱️ Breathing: O₂ therapy, nebulisers, NIV (CPAP/BiPAP) or intubation if resp failure.
• 🅲️ Circulation: IV access, crystalloid bolus (500 ml–1 L), monitor for response. Vasopressors (e.g. noradrenaline) if refractory shock. Treat arrhythmias.
• 🅳 Disability: Correct hypoglycaemia (IV glucose), treat seizures (IV lorazepam). Consider naloxone if opioid overdose.
• 🅴 Exposure: Sepsis 6 (ABx within 1 hr), thrombolysis/PCI for ACS, anticoagulate PE if suspected.

📈 Monitoring & Reassessment

• 📊 Continuous obs: HR, BP, RR, SpO₂, Temp, urine output.
• 🔄 Repeat ABCDE after each intervention — assess response.
• 📝 Document interventions, times, and patient response carefully.

🏥 Definitive Management & Higher Care

• ⚖️ Stabilise based on cause (HF, sepsis, arrhythmia, PE, etc.).
• 🚑 Transfer to HDU/ICU if ongoing organ failure or invasive monitoring needed.
• 🤝 Multidisciplinary approach: involve intensivists, cardiology, respiratory, surgery as appropriate.

🩺 Post-Crisis Care & Follow-Up

• 📑 Case review: What triggered deterioration? Missed early signs?
• 📌 Ongoing plan: Clear monitoring & escalation instructions.
• 🧠 Psychological support: For patient & family. Consider chaplaincy, psychology, or palliative team if needed.

💡 Key Clinical Pearls

• NEWS2 score ≥5 = red flag → urgent review.
• Always treat hypoxia and hypoglycaemia first — both rapidly reversible.
• ABCDE is iterative → reassess after each intervention.
• Never delay escalation — better to call early than too late.