Emma’s mother brought her to A&E after noticing that she had been lethargic, with a temperature of 38.9º C for the past 24 hours.
: Template word count = 690 Student word count =
2000-word Assessment
Overall, this is a 2000-word report in the format of a template. All 9 sections need to be completed. The Word count for students = 2000. Word count in template =690
Patient and Scenario Information
Name
Emma Johnson
Age/ DOB
7-year-old
Weight/Height
22kg
Gender
Female
Scenario Setting
Emma’s mother brought her to A&E after noticing that she had been lethargic, with a temperature of 38.9º C for the past 24 hours. The mother reports that Emma has been complaining of abdominal pains and she has vomited twice. She also mentions that Emma seems more irritable and hasn’t bee.n drinking much. A&E suspect sepsis.
Patient
Past medical History:
Information
No known allergies.
Emma has autism spectrum disorder
Social History:
Emma lives with her parents and brother. Her father and 5-year-old brother also have autism spectrum disorder.
Assessment Data
No use of accessory muscles No recessions
AVPU = A, alert but in pain
GCS = 13/15 (eye opening 3, verbal response 4, motor response 6)
PEARL = 3mm
Respiratory rate= 30
SpO2 = 95% on room air.
Peripheral Capillary refill time = 4 seconds
Temperature= 39.8 º C
Blood pressure = 85/45
No rashes but pale and mottled skin on extremities
Heart rate = 140
Urinary output decreased
No audible obstruction in airway
No visible obstruction in airway
Lethargic
Abdomen soft but tender
Blood sugar level= 4 mmol/L
Peripheries warm to touch
Introduction: students need to show the presenting condition and a brief outline of the plan of care and refer to the learning outcomes that will be covered. They will need to be succinct.
Provide a summary of the patient’s (Emma)presenting complaint and outline the plan of care. Brief overview of the learning outcomes that will be covered.
References not needed 100 words
Approx: 100 words
ABCDE Assessment: Students need to discuss why and when this is used and explore some of the advantages and disadvantages.
Discuss why and when an ABCDE assessment would be used. Appraise the ABCDE assessment by exploring the advantages, disadvantages and limitations.
References are needed in this section 150 words
Approx: 150 words
ABCDE Table
In the following table, demonstrate how the A-E assessment would be applied to recognise the acutely ill child in the scenario (Emma)
Students need to demonstrate how the A-E assessment would be applied to recognise the acutely ill child in the scenario. Here is part of the table as the students will see it.
They need to write in full sentences and provide references to back up statements made about normal values and the evidence base. They can bullet point the interventions/ management. (800 words)
ABCDE
Assessment
Intervention/Management/ Investigation
Rationale and Evidence- Base
Identify the correct assessment data that corresponds to each section of the ABCDE assessment.
Identify abnormal assessment data in relation to normal evidenced based ranges.
List the appropriate intervention/ management and/or investigation for the patient
Provide an evidenced based rationale for the intervention/ management and/or investigation based on the patient’s condition.
Airway
Assessment
Intervention/Management/ Investigation
Rationale and Evidence-base
Breathing
Assessment
Intervention/Management/ Investigation
Rationale and Evidence-base
Circulation
Assessment
Intervention/management/ investigation
Rationale and Evidence base
Disability
Assessment
Intervention/management/ investigation
Rationale and Evidence base
Exposure
Assessment
Intervention/management/ investigation
Rationale and Evidence base
Template word count = 690 Student word count =
Please calculate overall PEWS score
PEWS =
Have you set your alarm limits?
RR
SpO2
HR
BP
Other
Type of monitor
Does your patient have any additional risk factors?
NOT APPLICABLE
Risk Factor
THINK!
Baseline vital signs outside of normal reference ranges
Always score the relevant PEWS value even if this is normal for the patient (e.g. cardiac patient)
Vital sign:
Patient’s normal value:
Tracheostomy/Airway Risk
Do you need additional help in an airway emergency?
Invasive/Non-Invasive Ventilation/High Flow
Check oxygen requirement on additional respiratory support. Remember High Flow/BiPaP and CPAP score maximum of 4 on oxygen delivery
Neutropenic/Immunocompromised
Sepsis recognition and escalation has a lower threshold
<40 weeks corrected gestation
Sepsis recognition and escalation has a lower threshold (beware hypothermia)
Neurological condition (ie meningitis, seizures)
Remember to check pupillary response if anything other than Alert on AVPU
Neurodiversity or Learning Disability
Be aware of the range of responses to pain and physiological changes
Outlier
Do you need support from home ward/team?
National Paediatric Early Warning System Observation and Escalation Chart
Patient Name: Hospital No. NHS No.
Date of Birth:
Carer question : Ask your parent/carer: How is your child different since I last saw them? You decide if their response means:
Date Time
Date Time
W - Worse S - Same B - Better
A – Parent/Carer Asleep U – Unavailable
Respiratory distress
Severe
• Tripoding
• Supraclavicular recession
• Grunting
• Exhaustion
Impending respiratory arrest
Respiratory support device (RSD)
Frequency
W/S/B/A/U
Value
>50
50
45
Moderate
• Tracheal tug
• Intercostal recession
• Inspiratory or expiratory noises
40
35
30
25
20
15
10
<10
Severe Moderate
Mild None
≥95% 92% - 94%
≤91%
SpO2 probe change ( )
RSD CODE
(maximum score is 4)
100%
>50
50
45
40
35
30
25
20
15
10
<10
Frequency
W/S/B/A/U
Value
>50
50
45
40
35
30
25
20
15
10
<10
Severe Moderate Mild None
≥95%
92% - 94%
≤91%
SpO2 probe change ( )
RSD CODE
(maximum score is 4)
HF = High Flow BiP = BiPAP
CP = CPAP
Scores the maximum of 4
90%
80% 15
70% 10
60% 8
50% 6
40% 4
Other delivery methods
NP = nasal prongs
30% 2
28% 1
FM = face mask HB = head box NRB = Non-
rebreather
Score as per oxygen
24%
<21%
Document ‘Air’ or Value
Delivery method
/RSD flow rate
Value
>190
190
180
170
160
150
140
130
120
110
100
90
80
70
60
50
<50
>190
190
180
170
160
150
140
130
120
110
100
90
80
70
60
50
<50
0.1
<0.01
Value
>190
190
180
170
160
150
140
130
120
110
100
90
80
70
60
50
<50
Record position of BP taken by inserting relavant initials above systolic arrow
LA - Left Arm RA - Right Arm LL - Left Leg RL - Right Leg
Derogation Code if required:
Not attempted (No concern)
- NCO (this scores 0)
Unsuccessful attempt (Concern) - U4 (this scores 4)
Unsuccessful Attempt (No Concern) - U0 (this scores 0)
CRT
BP Value or Code
" v:shapes="Textbox_x0020_56" class="shape" v:dpi="96">>150
150
140
130
120
110
100
90
80
70
60
50
40
30
<30
≥3 secs
>150
150
140
130
120
110
100
90
80
70
60
50
40
30
<30
≥3
BP Value or
Code
>150
150
140
130
120
110
100
90
80
70
60
50
40
30
<30
≥3 secs
If V or less do GCS
A = Alert
Record in seconds
PEWS AVPU
≤2 secs
≤2 ≤2 secs
PEWS AVPU
V = Responsive to voice P = Responsive to pain U = Unresponsive
If asleep with no reason for altered conscious state (e.g. sepsis) write ‘asleep’.
Clinical intuition
If you’re feeling that the patient is ‘just not right’ despite a low PEWS or natural carer concern *(Y/N)
Trigger criteria Cause(s) for escalation: SC = Specific Concern CQ = Carer Question
CI = Clinical Intuition P = PEWS
0 = None
Blood glucose
Pain score
(as per local policy)
Value
>39
39
38.5
38
37.5
37
36.5
36
35.5
35
34.5
<34.5
New suspicion of sepsis or septic shock (Y/N)
Clinical intuition
(Y/N)
Trigger criteria Escalation level Escalated (Y/Plan)
Time NIC informed Time clinician informed Time clinician arrived PICU/transport team called
ESCALATION LEVEL
LOW (L)
MEDIUM (M)
HIGH (H)
EMERGENCY (E)
TRIGGER CRITERIA:
Respond as per the highest level based on
CHANGE in
ANY ONE
of these criteria
Specific concern (neurology, sepsis, or pre-existing risk factor)
New suspicion of sepsis
AVPU: Change to AVPU - V ‘ Responsive only to Voice’ or New suspicion of septic shock
AVPU: Change to AVPU - P or U ‘Res- ponsive only to Pain’ or ‘Unresponsive’ OR Abnormal pupillary response
Clinical Intuition
Nurse/clinician concern that patient needs increased monitoring despite low PEWS
Nurse/clinician concern that patient needs a medical review irrespective of PEWS
Nurse/clinician concern that patient needs a ‘Rapid Review’ irrespective of PEWS
Nurse/clinician concern that patient needs emergency review for
life-threatening situation
Carer Question
Carer uses words that suggests the child needs increased monitoring or intervention despite the low PEWS
Carer uses words that suggests the child needs a clinical review irrespective of PEWS
Carer uses words that suggests the child needs a ‘Rapid Review’ irrespective of PEWS
Carer uses words that suggests the child has collapsed or significantly deteriorated
Paediatric Early Warning Score
1- 4
5- 8
9- 12
≥13
Communication & response (use ISBAR Framework)
Medical plan for stabilisation Structured medical plan to be documented including:
specific actions to be taken
expected outcome
outcome deadline
escalation if outcome not met by deadline.
Inform Nurse-in-charge
Consider Medical Review by ST3+ or equivalent
Bedside nurse to feed back plan to parents
Review by Nurse-in-charge for potential escalation (and/or Outreach nurse or equivalent)
Request Medical Review by ST3+ or equivalent
Stabilisation plan to be considered
Bedside nurse to feed back plan to parents
Immediate review by Nurse-in-charge for potential escalation
Call for ‘Rapid Review’: Medical incl. airway skills ST3+ or equivalent and outreach nurse (if available or equivalent)
Stabilisation plan to be discussed with consultant
Senior nurse to feed back plan to parents
Immediate 2222 call: “Paediatric Medical Emergency” and review by Nurse-in-charge
Consultant informed urgently to confirm stabilisation plan
Senior nurse to support and feedback to parents
[In specialist environments rapid review can replace 2222 but only with prior agreement between consultant and nurse- in-charge]
Medical review timings
As agreed with medical team
Within 30 minutes
Within 15 minutes
Immediate
Minimal observations
Repeated escalation if remaining in one level not required but ongoing plan must be clearly documented in notes.
Must reassess within 60 minutes (and then document ongoing plan)
Must reassess within 30 minutes (and then document ongoing plan) Continuous Oxygen Saturation monitoring needed
Every 30 minutes and continuous monitoring of Respiratory Rate / Oxygen Saturation / ECG
GCS recording if change in AVPU
Every 15 minutes and continuous monitoring of Respiratory Rate / Oxygen Saturation / ECG
GCS recording if change in AVPU or abnormal pupillary response
FOR EMERGENCY OR LIFE-THREATENING SITUATIONS: CALL 2222 AND STATE “PAEDIATRIC MEDICAL EMERGENCY”
Signature
>39
39
38.5
38
37.5
37
36.5
36
35.5
35
34.5
<34.5
Blood glucose
Pain score
(as per local policy)
Value
>39
39
38.5
38
37.5
37
36.5
36
35.5
35
34.5
<34.5
New suspicion of sepsis or septic shock (Y/N)
Clinical intuition (Y/N)
Trigger criteria Escalation level
Escalated (Y/Plan)
Time NIC informed
Time clinician informed
Time clinician arrived
PICU/transport team called
THINK! Could this be sepsis?
Think sepsis if any of the following are present:
Neutropenia or immunocompromised (call medical professional for immediate review)
Known or suspected infection
Temperature ≥38°C or <36°C
Increasing oxygen requirement
Unexplained tachypnoea/ tachycardia
Altered mental state (e.g. lethargy/floppy)
Prolonged CRT, mottled or ashen appearance
If suspicion of sepsis, inform nurse in charge. Escalate to patient’s own or on-call team.
Signature
Escalation:
Using the PEWS score, discuss the escalation response you would follow for this patient and when you would consider escalating this patient.
Approx 100 words
Communication:
Examine the effectiveness of using communication strategies within healthcare and appraise the SBAR communication tool considering the advantages and limitations.
In the table below, provide an example of the SBAR discussion you would use in escalating this patient.
Approx 300 words
Situation
Background
Assessment
Recommendation
Citation
Reference List:
REFERENCES
Need to be in the Harvard style of referencing as per university guidelines. 15 refs as a minimum.
Guidelines should refer to reputable resources
1) NICE guidelines
2) RCPCH website
3) NHS England website
4) RCN
5) BTS and SIGN
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