Introduction

A=AIRWAY, 
B=BREATHING, C=CIRCULATION, D=DISABILITY OF THE CENTRAL NERVOUS SYSTEM, E=EXPOSURE

Patients admitted to hospital with acute illness deserve the best possible care and need to feel confident that if their condition deteriorates they will receive prompt and effective treatment. Unfortunately there is evidence to the contrary indicating that there can be a failure to recognise patients at risk or who are deteriorating. The failure to recognise and respond to acute patient illness and deterioration may result in severe consequences for patients.

The National Institute for Health and Care Excellence (NICE, http://www.nice.org.uk/) published NICE clinical guideline 50, Acutely ill patients in hospital: recognition of and response to acute illness in adults in hospital in July 2007. The report contained practical guidance with recommendations for the measurement and recording of a set of physiological observations, linked to a ‘track and trigger’ system. There was emphasis on the importance of a full clinical assessment and the need for improved training in the necessary competencies.

In response to reports such as NICE clinical guideline 50, the University of Leeds has developed the Recognising and Responding to Acute Patient Illness and Deterioration (RRAPID) course. The philosophy of the course is to emphasise timely and rapid response to the acutely ill patient and equip medical students with the appropriate skills to manage such patients upon graduation.

The RRAPID course runs throughout the University of Leeds undergraduate curriculum. The principles not only encompass the management of the episode of acute illness but also encourages the students to determine how the episode could have been prevented and the longer term management objectives. Within the curriculum RRAPID encourages the students to learn the physiology of health and the pathophysiology of illness in the context of acutely ill patients. There is the opportunity to practice clinical assessment, communication skills, decision making, infection prevention, time management, patient safety and prescribing in the protected environment of simulated scenarios.

The RRAPID assessment of the acutely ill patient revolves around the traditional ABCDE systems based approach:

  1. AIRWAY
  2. BREATHING
  3. CIRCULATION
  4. DISABILITY
  5. EXPOSURE

The authors of this book include frontline clinicians and healthcare professionals. It has been created with the help of both undergraduate and post graduate trainees. The information included in this book is up to date with current clinical practice and national and local guidelines used in Leeds Teaching Hospitals. However, it is recommended that users outside of Leeds consult local protocols and guidelines. In all case specific drug doses should be checked in the British National Formulary. Further information regarding the RRAPID course and the companion app can be found at www.rrapid.leeds.ac.uk.

Each section follows a similar structure:

BASIC ANATOMY AND PHYSIOLOGY

A brief introduction to the relevant anatomy and physiology of each system is given. This aids understanding of the causes of each system dysfunction leading to patient deterioration.

COMMON CAUSES OF SYSTEM DYSFUNCTION

For each system (ABCDE), there is a list of the pathologies causing system dysfunction. This will concentrate on the more common pathologies but also cover some of the less common life threatening problems.

CLINICAL PRESENTATION

Recognising the acutely ill and deteriorating patient is the essential first step. Patients will present in different ways but this section will describe the common symptoms and signs of deterioration within each system.

IMMEDIATE RECOGNITION AND RESPONSE

Simple but effective early interventions are described. These can be performed by junior medical staff, which at an early stage may significantly improve the patient’s outcome.

FURTHER MANAGEMENT

Following the immediate recognition and response to acute illness and deterioration, patients require more specific management which is dependent upon the clinical context. This section describes the management of specific diseases related to each system in more detail.

PREVENTION

There can be opportunities for preventing acute illness and deterioration. Learning to recognise the patient who is at risk of deterioration before they deteriorate is an important step to reducing the morbidity and mortality from acute illness in hospital. Simple actions can be performed either to prevent problems occurring initially or to aid prompt recognition and response before the deterioration becomes too far advanced.

CASE STUDY

A clinical case scenario specific to the organ system is described to illustrate how the RRAPID approach should be used in clinical practice. Questions are posed to test the reader's ability to manage acutely ill patients.

KEY LEARNING POINTS

Each chapter ends with a brief summary box with key learning points.

SELF TEST QUESTIONS

Interactive cases and multiple choice questions are provided to test the reader's understanding of a topic.

CASE LOG

During your clinical placements you will encounter acutely unwell patients. In the case log section you will be able to document and reflect upon cases that you come across and save these notes to your device or e-mail them to yourself. The case log utilises the commonly used communication tool SBARR. This enables you to enter the details under the appropriate section i.e. situation, background, assessment (use the ABCDE approach), recommendations and readback. It is important that you do not enter any specific patient identifying information (name, date of birth, hospital number) for clinical govenance reasons.

GLOSSARY AND ABBREVIATIONS

A glossary of terms and list of abbreviations used throughout the ebook.