The Routine Round Patient Assessment

Gather information to diagnoses or predict problems, and plan for them.

Chart Review
Obs and fluid charts are essential
- look at absolute values and trends

Logical approach to charts
R : Respiratory
- rate
- FiO2, Sats
C : Circulation
- rate and rhythm
- BP
- urine output
- IV lines & fluid balance
- CVP and pulmonary wedge P
S : Surgical
- temperature
- drainage (nature and volume)
- special requirements
D : Drug chart

History and Physical
Remember comorbid conditions are almost as important like their present illness.
Examine fully paying attention to regions involved in surgery or underlying disease.
- remember wounds and stomas
Repeated clinical examination is essential.
- eg atelectasis is much more likely to be detected clinically.

Review results
Even in emergencies recent routine blood tests, microbiology or imaging may be available.
In ward rounds, wait at the end of the bed for tests to become available.

Decisions and Planning

Stable Patients
Be cautious about calling recent-responders stable.
Plan daily for wards, twice daily in HDU.
Predict complications based on comorbid conditions.

Daily Plan:
Investigations
Removal of drains / tubes
Oral intake
Fluid balance and Rx
Nutrition
- requirement and route
- is it being given?
Physiotherapy
Drugs / analgesia
- therapeutic
- preventive eg DVT prophylaxis
- routine meds
Move to lower level of care

Unstable Patients
If progress is not satisfactory then further investigations and definitive Rx is required.
- review your priorities
- is resuscitation requried?
- begin treatments early.
- inform your senior
- is a higher level of care required?
- are you reaching a diagnosis quick enough?
- are you even reaching the diagnosis?

Investigations:
- Find out why the pt is unwell.
- eg CXR, ECG, Blds, Cultures.
--> Remember the radiology department is unsafe for unstable pts.
Specialist opinions may be required.

Note Writing

Name (capitals), date, time, pager
Assessment:
- past and present events
- present clinical features
- response to treatments given
Differential diagnosis
Plans, including:
- communications
- review (by you or others, when)
- parameters for change.