Recognising the deteriorating patient

Abstract

A 75 year old man is admitted to hospital with severe chest pain. The figure⇓ shows his observation chart. Observation chart of patient with severe chest infection ### 1 What is the first sign on this chart of important clinical deterioration? An increasing respiratory rate is the first and most important indicator of severe illness, although anecdotally it is the vital sign least accurately calculated. Extensive research into predictors of mortality based on observation charts has shown that a respiratory rate greater than 27 breaths per minute is an important predictor of cardiopulmonary arrest.1 Interestingly, at first glance the vital sign that stands out the most on this observation chart is the decrease in blood pressure; a fall in blood pressure is, however, a late sign of deterioration. Another relevant sign of clinical deterioration is an increasing requirement for oxygen to maintain adequate saturations—in other words, a change from room air to 2 L/min of oxygen …