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

3. A: Unsure what problem is but patient is deteriorating .
S: Mrs A, 96yrs 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 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:
iSTAT bloods to check renal function and lactate
Cannulate for trial 24hrs 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.

4. S: Mr B, 93yrs, 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 NEWS 2
Crackles evident to Left base with reduced air entry bilaterally.
Diagnosis: LRTI
Plan:
Bloods to check inflammatory markers. If raised for 24hrs 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 24hrs. EoL care commenced, anticipatory meds prescribed and discharged back to care of GP and DNs.