The identification of a deteriorating patient has been poorly managed within the healthcare
setting. Usually there are discernible physiological changes which occur prior to adverse events
such as cardiac arrest, unexp
...
The identification of a deteriorating patient has been poorly managed within the healthcare
setting. Usually there are discernible physiological changes which occur prior to adverse events
such as cardiac arrest, unexpected admission to the ICU and unexpected death. As this is a
stressful situation it is easy to omit essential strategies. Patients can deteriorate rapidly or over a
period of several hours. Health professional often miss the signs of deterioration as they fail to
systematically assess their patients.
A set of strategies was developed to identify and manage the deteriorating patient. The first
step is to assess the patient using the ABCDE algorithm which is a systematic assessment known
as the primary survey and can be used with all patients. The clinical signs of critical conditions
are similar regardless of the underlying condition. The initial assessment and treatment are
performed simultaneously and continuously. This would also include taking a full set of vital
signs and comparing to previous readings. The patient is assessed in the following order
A: Airway
B: Breathing
C: Circulation
D: Disability (neurological function)
E: Exposure
The approach to all deteriorating or critically ill patients is the same. The underlying principles
are:
Do a complete initial assessment and re-assess regularly.
Treat life-threatening problems before moving to the next part of the assessment.
Assess the effects of treatment.
Recognise when you will need extra help. Call for appropriate help early.
Use all members of the team. This enables interventions (e.g. assessment, attaching
monitors, intravenous access), to be undertaken simultaneously
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