IMMEDIATE ASSESSMENT OF THE CRITICALLY ILL (NEWS)

• ABCDE: IMMEDIATE ASSESSMENT AND INTERVENTION.

1. AIRWAY: check there is no problem with the airway, the airway can be maintained with a jaw thrust or chin lift. Placing the patient in the recovery position may be necessary (if no sign or suspicion of spinal injury). Use a Guedel oral airway if tolerated. Administer high-flow oxygen immediately. Look, listen and feel for expired air.

2. BREATHING: 

-Count the respiratory rate: less than 10 (imminent respiratory arrest), more than 20 (ill) and more than 30 (critically ill).

-Listen for noise and assess the effort.

-Perform oximetry.

-Continue high-flow oxygen.

-Keep the saturations greater than 90%.

3. CIRCULATION:

-Assess pulse rate and strength.

-Assess capillary refill.

-Measure the blood pressure.

4. DISABILITY:

-GCS

-Assess pupil size, equality and reaction.

-Measure blood sugar.

5. EXPOSURE:

-Look for a rash and signs of trauma.

-Check for hypothermia.

-Look in the mouth (tongue biting).

• EARLY WARNING: TRACK AND TRIGGER SYSTEMS.

1.  MEDICAL EMERGENCY TEAM CALLING CRITERIA.

2. EARLY WARNING SCORE (EWS AND NEWS) SYSTEMS.

Link to NEWS chart: National Early Warning Score (NEWS)

The NEWS system is a standarised track-and-trigger system that makes recommendations on the urgency of the clinical response required, the clinical competency of the clinical responders and the most appropiate environment for ongoing clinical care.

When a patient is acutely unwell and presents to hospital, or deteriorates and becomes acutely unwell whilst in hospital, time is of the essence and a fast and efficient clinical response is required to optomise clinical outcomes. Current evidence suggests that the triad of:

-early detection,

-timeliness of response and

-competency of the clinical response

is critical to defining clinical outcomes.

NEWS should not be used in patients under 16 years old or during pregnancy.

The National Early Warning Score system has 6 parameters:

1. Respiration rate:

-Causes of high respiration rate: acute illness and distress, generalised pain, sepsis remote from lungs, CNS disturbance and metabolic disturbances such as metabolic acidosis.

-Causes of low respiration rate: CNS depression and narcosis.

2. Oxygen saturations: assessment of pulmonary and cardiac function, it also takes into account if the patient is on any supplemental oxygen.

3. Temperature: pyrexia and hypothermia are extremes of temperature, sensitive markers of acute illness severity and physiological disturbance.

4. Systolic blood pressure: 

-Hypotension: may indicate circulatory compromise due to sepsis or volume depletion, cardiac failure or cardiac rhythm disturbance, CNS depression, hypoadrenalism and/or effect of blood pressure lowering medications. 

-Hypertension: an elevated blood pressure is an important risk factor for cardiovascular disease but it is the low systolic pressure that is most significant in the context of assessing acute illness severity.

5. Pulse rate:

-Tachycardia: may be indicative of circulatory compromise due to sepsis or volume depletion, cardiac failure, pyrexia or pain and general distress. It may be also due to cardiac arrhythmia, metabolic disturbance or drug intoxication.

-Bradycardia: may be on indicator of hypothermia, CNS depression, hypothyroidism or heart block.

6. Level of consciousness:

-A: the patient is awake.

-V: the patient responds to verbal stimulation.

-P: the patient responds to painful stimulation.

-U: the patient is completely unresponsive.

Urine output monitoring is essential for some patients as dictated by their clinical condition (e.g: sepsis) and this must be included on the fluid balance chart.

There are two mechanisms based on the NEWS which can trigger a clinical response:

-a score of 3 in any one parameter, or

-a total NEWS of 5 or more.

NEWS score: 0

NEWS score: 1-4

NEWS score: a score of 3 in any one parameter, or a total NEWS of 5 or more.

NEWS score: 7 or more.

NEWS is an aid to clinical assessment and not a substitute for competent clinical judgement. Clinical concern about a patient´s condition should always override the NEWS score.


Source:
-A nurse´s survival guide to acute medical emergencies, R. Harrison and L. Daly, Elsevier 2011.
-http://tfinews.ocbmedia.com/