Recognising The Deteriorating Patient

Recognising a patient who is becoming or about to become seriously unwell, for any reason, has often relied on the nurse's intuition (Hams 2000) and unspecified 'concern' remains a valid reason for calling for help (Buist et al. 2002). However, in recent years there has been an emphasis on a systematic approach to patient assessment and the calling of rapid medical assistance based on objective criteria.

Similar to the assessment of a collapsed patient, immediate assessment of an acutely ill patient is based on the ABCDE system (Ahern & Philpott 2002, Anderson 1999, Smith 2003).

A Airway B Breathing

C Circulation D Disability E Exposure

Patient assessment should only proceed to the next letter following full assessment and any necessary treatment from the previous one. For example, a blocked airway should be treated urgently; progression to assessment of breathing should occur only when the airway is open. Assessment includes the use of clinical assessment tools and monitoring with available equipment, though monitoring equipment should augment rather than replace assessment skills.

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