Airway (A)

Own, no airway compromise

Breathing (B)

RR 24 SpO2 88% on air

Right-sided basal crackles

Circulation (C)

HR 130 irregular BP 89/50 CRT 2 seconds centrally but hands feel cool to touch

HS 1+2+0

JVP not visible, looks dry with no peripheral oedema

Pad moist, dark, strong smelling urine

Disability (D)

GCS E3M5V5=13/15 BSL 10.2

PERLA 3mm

Left-sided facial weakness

Left-sided hypertonia with contractures. Right side normal tone but unable to complete full neurological examination due to confusion/drowsiness

Exposure (E)

Pyrexial 38.5°C

No rash

No evidence head injury or other injury

What happens next…

This is a gentleman who is frail with many comorbidities. Some initial investigations suggest a pneumonia again.

After starting some fluids and antibiotics the scenario progresses to the point where the family ask: “What is the point in the antibiotics they never seem to work?”

The participating clinician should be thinking: “Is this the best for the patient? Does he need an escalation plan or DNACPR?”

If the participant hasn’t expressed these thoughts – the family member will continue with prompts until the nurse mentions it.

Learning Outcomes