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Vital Signs
Read the illustrated guide to the various vital signs on ClinicalSkills.net here:
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Measuring blood pressure part 1: equipment
Measuring blood pressure part 2: procedure
Measuring blood pressure part 3: the patient
Recording temperature: Tympanic thermometers
Recording temperature: Electronic thermometers
ABCDE approach
Read about the ABCDE approach from the Resuscitation Council (UK):
The ABCDE Approach | Resuscitation Council UK
NEWS 2
Recording and interpreting the National Early Warning Score 2 (NEWS2)
Watch
Watch
Vital Signs
The following videos break down the key steps in the vital signs process, focusing on each individual skill in turn:
Vital Signs - Measuring Respiratory Rate
Vital Signs - Measuring Oxygen Saturation
Vital Signs - Measuring the Pulse
Vital Signs - Measuring Blood Pressure Manually
Vital Signs - Measuring Blood Pressure using an Automated Device
Vital Signs - Measuring Temperature
Measuring level of alertness (using the ACVPU scale)
A to E Assessment
The 2 videos below illustrate the A to E approach to assessment. The first is from the Resuscitation Council UK and the second is produced by Sheffield Hallam University and looks at the patient journey of a female with sepsis, from recognition of the unwell patient to involvement of the wider team and escalation of the patient's care, focusing on A to E assessment, treatment and management and communication:
A good video on The ABCDE Assessment by the Resuscitation Council can be found here
Recognition and management of an unwell patient using the A to E assessment and multidisciplinary team approach
National Early Warning Score - NEWS2
The following videos look at NEWS2 (the National Early Warning Scoring tool), its origin and development, importance, benefits of its use and how it can be used to help to detect early deterioration of patients to improve patient care.
NEWS2
NEWS2 - calculating and recording a score
Recognising Deterioration in People with Learning Disabilities
The following video considers the recognition of deterioration in people with learning disabilities and gives useful tips on atypical signs that may indicate deterioration in a patient, particularly those who have difficulty communicating:
Check your Knowledge!
Check your Knowledge!
Click on the button below to navigate to the 'Take a Test' area of ClinicalSkills.net. Please make sure you're logged into ClinicalSkills.net already, otherwise you may not be able to open and take the test. Once you have reached the 'Take a Test' area, select 'Standard Tests' and then click on the test called 'Observations' to begin. You will need to score 90% or more to pass. Make sure you've read the ClinicalSkills.net procedure thoroughly before taking the test as many of the answers will be found within there!
Procedural Checklists
Procedural Checklists
Here you can open the step by step virtual checklist, which you can use on a smartphone or tablet:
Alternatively, you may wish to use the paper version of this, which you can open here (and print if required):
Other Materials
Other Materials
National Patient Safety Alerts
To see the full alert click onto the attachments within the document.
National Patient Safety Alert - Adoption of NEWS2:
www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=102721
National Patient Safety Alert - Risk of harm from inappropriate placement of pulse oximeter probes
www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=102821
Royal Marsden Manual of Clinical Procedures (9th Edition): Observations- Page 464- 472 & 478- 498 & 502-508
Physical health in people with Mental Illness or Learning Disabilities
People who have a Serious Mental Illness or a Learning Disability have a shorter life expectancy than the general public, often a physical illness can exacerbate their mental illness or in the case of a person with a Learning Disability a physical illness can be perceived as a behavioural problem or as being characteristic of the person’s learning disabilities. This can lead to Diagnostic Overshadowing, a term used to describe a situation when a physical illness is overlooked due to the misattribution of any physical symptoms shown to their mental illness or learning disability, often leading to a delay in, or, inadequate treatment.
People living with severe mental illness (SMI) have a life expectancy of 15–20 years lower than the general population partly due to physical health needs being overlooked. Individuals with SMI also have double the risk of obesity and diabetes, three times the risk of hypertension and metabolic syndrome, than the general population. In people with Learning Disabilities gastrointestinal cancers are approximately twice as prevalent, coronary heart disease is the second highest cause of death and approximately 70% of people with a learning disability experience gastrointestinal disorder.
It is important to understand that a change in a person’s normal presentation whatever that may be should trigger physical health checks alongside any checks that would be done for their mental health or Learning Disability. The ABCDE approach is, as you will read a systematic approach to gather information about your patient when their condition is deteriorating – when there has been a change no matter what that change may be, assessing their physical health will ensure that there is no delay to, or inadequate treatment given.
References and further reading
Death by indifference:
Confidential Inquiry into premature deaths of people with learning disabilities (CIPOLD):
https://www.bristol.ac.uk/media-library/sites/cipold/migrated/documents/fullfinalreport.pdf
Improving physical healthcare for people living with severe mental illness (SMI) in primary care:
Overshadowing and Other Challenges Involved in the Diagnostic Process of Patients with Mental Illness Who Present in Emergency Departments with Physical Symptoms – A Qualitative Study Shefer, G., Henderson, C., Howard, L., Murray, J., & Thornicroft, G. (2014):
https://doi.org/10.1371/journal.pone.0111682
Health inequalities and people with learning disabilities in the UK. Emerson, E., & Baines, S. (2011):
https://doi.org/10.5042/tldr.2011.0008
Improving the physical health of people with mental health problems:
Clinical assessment of Black Asian and Minority Ethnic (BAME) skin
Recognising clinical signs such as cyanosis and pallor in BAME skin is not the same as recognising these signs in white skin, therefore creating issues when conducting a comprehensive ABCDE assessment. Although noted in many articles, the lack of examples and particularly pictures of black Asian and minority ethnic skin in clinical education has not been rectified until recently.
A recent example of this is discussed by Lynch 2020 whilst exploring the prevalence of Covid in the BAME community stating, there is a failure in clinical education to visually show a variety of presentations and clinical signs seen in all ethnicities. Concluding that If clinicians cannot identify these signs, unwell patients will not be appropriately treated leading to increased morbidity and mortality in the BAME population.
In August 2020 medical student Malone Mukwende concurred, stating “If the doctors of tomorrow are better equipped to deal with how signs and symptoms present on black and brown skin, this will improve patient care and reduce the healthcare disparities that exist today.” Wanting to rectify this he worked with, Senior Lecturer in Diversity and Medical Education, Margot Turner, and Clinical Lecturerin Clinical Skills, Dr Peter Tamony from St Georges University of London and developed the Mind the Gap handbook, which shows pictures of cyanosis, pallor, rashes etc on BAME skin. The handbook that will grow and develop over time as clinicians share their work and observations.
Please click onto the links below that will take you to the handbook itself and the website linked to further versions.
Mind the Gap - A Handbook of Clinical Signs in Black and Brown Skin:
https://ndownloader.figstatic.com/files/24163535
Black and Brown Skin - Website
sites.google.com/my.shu.ac.uk/smart-manual-2020/part-1-introduction
References
Lynch, C. (2020). Diversifying medical school education to represent BAME backgrounds. BMJ, 370, m2745–. https://doi.org/10.1136/bmj.m2745
Date reviewed:
Next review: August 2023
Page updated
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