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Health Assessment · Chapter 2

Notice, Decide, Escalate

Patients who deteriorate usually show abnormal vital signs for six to eight hours first — the deterioration is rarely missed because it was invisible, it is missed because it was recorded and not acted upon. Read five patients and decide between routine monitoring and a rapid response, then build the phone call itself in SBAR and have every line scored.
Choose a patient
What do you do right now?
Read the findings, then choose
Recognizing deterioration is only half the skill. The other half is deciding, out loud and on the record, what happens in the next five minutes.
0 / 5
patients triaged correctly
Why respiratory rate is the number that matters
upper limit of normal — 20/min red flag — over 28/min arrest 8 hrs before 4 hrs before now Every one of these was charted. None of them was acted upon.
Failure to rescue. Respiratory rate is the most sensitive and the most frequently falsified vital sign on the flowsheet. Count it for a full minute. And “something is wrong” with no number to point to is itself a legitimate rapid response trigger at most facilities — if you are debating whether to call, you have already answered the question.