What early clinical indications are there that Matthew is seriously unwell?
What will be an ideal response?
Suggested response: Within 4 hours of arrival Matthew is deteriorating. While his initial observations would not trigger an automatic escalation, he is noted to be drowsy with a change to his GCS. The case study notes that he is usually independent and again, given his medical history, he is at an increased risk for deterioration and this is an indication that he is unwell. Matthew's second set of observations includes a raised temperature and should get him some blood cultures and empirical antibiotic cover. It was noted that he was cultured but no antibiotic was administered. This may be because the clinicians are biased by the abdominal signs. Matthew's renal history would naturally lead clinicians to be cautious in fluid delivery. However, he was appropriately given a fluid bolus (given his history of hypertension). Further sets of observation are not noted so it is unclear if he requires further fluid. One of the most common recommendations of noted deterioration is the requirement to increase the frequency of observation. Audit often reveals, however, that even after acute events there is a failure in this area so it is difficult to monitor patient progress.
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