Synopsis
Measure and interpret core observations, obtain reproducible peak flow and diagnostic-quality 12-lead ECGs, and move patients safely while recognising deterioration and limits of competence.
- Confirm identity, indication, baseline, equipment function and infection precautions before every measurement.
- Count respiratory rate without prompting when possible; effort, speech and pattern can be more urgent than the number alone.
- NEWS2 uses respiratory rate, oxygen saturation, systolic pressure, pulse, consciousness/new confusion and temperature, with extra points for supplemental oxygen; it supports escalation but does not replace judgement.
Key red flags
Airway threat, severe work of breathing, shock, reduced consciousness or extreme observation requires ABCDE treatment and early help.
Acute ST elevation, broad tachycardia, high-grade block or rhythm linked to instability needs immediate escalation.
Reasoning priorities
Quantify physiology and detect acute change.
Use context, device, oxygen status and prior values; escalate clinical concern despite a low score.
Worked reasoning
A patient scheduled to walk to a chair is newly breathless, with respiratory rate 30 and oxygen saturation 88% on air.
- Stop the transfer, call for help and assess ABCDE while confirming the oximeter signal, pulse agreement, oxygen prescription and complete observations.
- Reason that marked hypoxaemia and tachypnoea require immediate treatment and escalation, not a NEWS2 calculation or peak-flow attempt before action.
- Apply authorised emergency measures, obtain senior review and move only if clinically necessary with monitoring, adequate staff and equipment.
- Verify response by repeating observations after intervention, documenting oxygen/device and communicating trend and destination handover.
Peak flow is requested in a stable person able to cooperate.