on my last day with my mentor of a medical ward we had a pt going septic and the doctors were well aware and planing to step him up to mdhu or itu.
Avpu is part of out ews, this patient only seemed to have a response when he checked his blood glucose(for hourly sliding scale), he moved the hand away slightly no eye opening. I assesed this as a reaction to pain. he hadn't been diagnosed as diabetic very long so his finger tips were still pristine.
a pain response is a 2 and combined with other factors made him a ews=5
and then we tell a SpR (registar)
having had neuro experience i find avpu unclear GCS is more discreet
and he would have been 6-7
i have never had clear teaching of this tool, had an pt with know eplisey, and dementia 'go vacant' on me whilst i was giving her her medicines, had been handed over that she was been like this yesterday, wasn't responding to voice though normally would, applied sternal pressure to get response and checked obs a. when is used pain in these situations i've not got eyes open, anyone know any resources?
I got lost on Jane's abbreviations big time!! Lucky for me the most we have is patients who we class as being HDU - I can cope with that one!!
I liked the "hot tool" we used in the last trust I worked in (about the only thing I liked ) It was simple, easy to follw & gave clear directions as to what the next step was. Every nurse was issued with a small, credit card sized, laminated version to keep with them. It was a really good idea & was done in conjunction with a really active critical care outreach team. It truly was great & I'm sure it must have made a difference to intensive care admission rates.
RGN1
1,700 Posts
I got lost on Jane's abbreviations big time!!
Lucky for me the most we have is patients who we class as being HDU - I can cope with that one!!
I liked the "hot tool" we used in the last trust I worked in (about the only thing I liked
) It was simple, easy to follw & gave clear directions as to what the next step was. Every nurse was issued with a small, credit card sized, laminated version to keep with them. It was a really good idea & was done in conjunction with a really active critical care outreach team. It truly was great & I'm sure it must have made a difference to intensive care admission rates.