Toolbox

The National Early Warning Score (NEWS) is a simple system which assigns a score to routine physiological measurements. Six physiological parameters form the core of the NEWS system:

1. Respiration rate
2. Oxygen saturation
3. Systolic blood pressure
4. Pulse rate
5. Level of consciousness or new confusion*
6. Temperature

*New onset confusion, disorientation or agitation where previously their mental state was normal. This may be subtle and the patient may still respond coherently to questions with some confusion, disorientation and/or agitation.

This would score 3 or 4 on the Glasgow Coma Scale (rather than 5 for normal verbal response) and as such scores 3 on the NEWS system.

A score is allocated to each parameter as they are measured, with great variance from the norm reflecting a higher score.

This score is then aggregated but can be further uplifted for those who require oxygen to maintain their recommended oxygen saturations.

This is a pragmatic approach based on a system-wide approach and the use of routinely measured physiological parameters.

Resource - https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2

Resource - FMED 1061

Rhythm Recognition - The 6 Stage Approach

Experience and expertise may be required to identify some rhythm abnormalities, however the UK Resuscitation Council advocate the use of a simple 6 stage approach which will define a rhythm in suffiecient detail to enable selection of an appropriate immediate treatment.

Any cardiac rhythm can be described accurately using steps 1-4 which will inform safe and effective management. Do not go further to steps 5 and 6 unless you are confident that you can see atrial activity.

Cardiac Arrest Rhythms

Tachyarrythmia

Bradyarrythmia

Quick Look Features

Chemical Primary Survey

1. Very Seriously Ill (VSI). A patient is termed ‘very seriously ill’ when his/her illness or
   injury is of such severity that life or reason is immediate endangered. An example would
   be a casualty who requires ventilation following injury.
2. Seriously Ill (SI). A patient is termed ‘seriously ill’ when his/her illness or injury is of such severity that there is cause for immediate concern, but there is no imminent danger to life. An axample would be a patient who is extubated post - operatively, but has required a limb amputation
3. Ill. Incapacitating injury/illness. A patient has an incapacitating illness or injury if their illness or injury does not warrant classification as VSI or SI, but renders them physically and/or mentally incapacitated.
4. Unlisted Casualties (UL). An individual whose illness or injury requires hospitalisation but whose condition does not warrant classification as VSI, SI or ILL.

Four Quadrant Model