Routine Round Patient Assessment
Gather information to diagnoses or predict problems, and plan for them.
Obs and fluid charts are essential
- look at absolute values and trends
Logical approach to charts
R : Respiratory
- FiO2, Sats
C : Circulation
- rate and rhythm
- urine output
- IV lines & fluid balance
- CVP and pulmonary wedge P
S : Surgical
- drainage (nature and volume)
- special requirements
D : Drug chart
Remember comorbid conditions
are almost as important like their present illness.
Examine fully paying attention to regions involved in surgery or
- remember wounds and stomas
Repeated clinical examination
- eg atelectasis is much more likely to be detected clinically.
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
Be cautious about calling recent-responders stable.
Plan daily for wards, twice daily in HDU.
Predict complications based on comorbid conditions.
Removal of drains / tubes
Fluid balance and Rx
- requirement and route
- is it being given?
Drugs / analgesia
- preventive eg DVT prophylaxis
- routine meds
Move to lower level of care
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?
- 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.
Name (capitals), date, time, pager
- past and present events
- present clinical features
- response to treatments given
- review (by you or others, when)
- parameters for change.