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An early warning system (EWS), sometimes called a between-the-flags or track-and-trigger chart, is a clinical tool used in healthcare to anticipate patient deterioration by measuring the cumulative variation in observations, most often being patient vital signs and level of consciousness. [1]
Vital signs (also known as vitals) are a group of the four to six most crucial medical signs that indicate the status of the body's vital (life-sustaining) functions. These measurements are taken to help assess the general physical health of a person, give clues to possible diseases, and show progress toward recovery.
Other terms used include grave, extremely critical, critical but stable, serious but stable, guarded, [3] and satisfactory.. The American Hospital Association has advised doctors not to use the word "stable" either as a condition or in conjunction with another condition, especially one that is critical, as it inherently implies unpredictability and the instability of vital signs. [2]
The Revised Trauma Score is made up of three categories: Glasgow Coma Scale, systolic blood pressure, and respiratory rate. The score range is 0–12. In START triage, a patient with an RTS score of 12 is labeled delayed, 11 is urgent, and 3–10 is immediate.
When reviewing vital signs in each of the age groups, be alert for significant changes and compare with normal values for each of the signs. For best results, when taking vital signs of infants, respirations are counted first before the infant is disturbed, the pulse next, temperature, and then blood pressure last. [16]
Portsmouth sign is most often noted clinically when reviewing observations charts which often plot SBP and HR on the same axis, allowing direct observation of situations in which SBP falls below HR. Patients exhibiting this sign are likely to be significantly fluid depleted and in urgent need of aggressive fluid resuscitation.
It is used for alert (conscious) people, but often much of this information can also be obtained from the family or friend of an unresponsive person. In the case of severe trauma, this portion of the assessment is less important. A derivative of SAMPLE history is AMPLE history which places a greater emphasis on a person's medical history. [2]
The first changes in vital signs seen in hypovolemic shock include an increase in diastolic blood pressure with narrowed pulse pressure. [4] As volume status continues to decrease, systolic blood pressure drops. As a result, oxygen delivery to vital organs is unable to meet the oxygen needs of the cells.