EMERGENCY MEDICINE GUIDELINES for ACE the ACEM
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Handing over a patient

How to make a referral to an Inpatient Team
 
An SBAR approach is a good system to ensure you give all the details in a systemic way. Think about what the person you are speaking to will want to know, have the notes, drug chart and observation sheets available so that you can answer any appropriate questions
 
Introduction
  • Explain your name, role and division
  • Explain what you want from them (e.g. I’m ringing for your advice or I’m ringing because I have a patient who needs a paediatric review or I’m ringing as I have a patient who I think needs admission)
 
‘Hi, it’s Nicholas from Children’s ED. I am phoning because I have a child who needs a paediatric review for possible admission’
 
Situation (core details)
  • Patient Details (Name, age)
  • Patient Location
  • Presenting Problem or Major Complaint (Reason for referral)
 
‘The patient is Jack Smith, a 3 year old boy with a viral induced wheeze in bed 8, who I am referring for your opinion because he is still only stretching an hour after initial burst therapy and is now hypoxic requiring 2 L of O2 to keep his oxygen sats at 92%’
 
Background (admission and history)
  • Past medical history
  • Previous admissions
  • Any other relevant history and important negatives
 
‘He has had a runny nose for 2 days and increased work of breathing since this morning. Jack has had two previous presentations with the same problem, once requiring high flow oxygen. He has never needed ICU. He doesn’t really suffer with any interval symptoms and only seems to get wheezy with a viral illness. He is otherwise atopic with hay fever and eczema but has no other significant medical history. Mum is especially concerned as her sister died of asthma in childhood.’
 
Assessment
  • Vital Signs
  • Examination findings
  • Investigations received/ pending
  • Management so far
 
‘On arrival he had a widespread bilateral wheeze and a tight sounding chest. There were no focal signs on the chest. He responded to an initial burst with some improvement in air entry but we have been unable to stretch him beyond 45 minutes. He has had prednisolone 2mg/kg and currently has EMLA on in case he needs an IV line and therapy. His current HR is 156, Sats 92% on 2L NP, RR 46 with a CEWT score of 5. He has been afebrile throughout’
 
Recommendation
  • Diagnosis/ Differentials
  • Management Plan
 
‘I think he has a viral induced reactive airways disorder with some response to salbutamol but think he may need escalation to IV therapy and an extended stay due to his slow salbutamol stretch.’
 
Practice creating SBAR’s for the following situations or about patients you have seen over the first week. You can create your own history, PMH, observations and examination to suit each situation
  • A 5 year old boy with a fever, likely UTI and previous diagnosis of ureteric reflux
  • A 4 day old baby with Jaundice and 11% weight loss since birth
  • A 2 year old girl with a complex febrile seizure
  • A 7 year old boy with a fever and petechial rash
  • A 3 month old girl with bronchiolitis and poor oral intake
Copyright © 2015
  • Home
  • Guidelines
    • AAA Rupture
    • Acute Coronary Syndrome
    • Anaphylaxis
    • Aortic Dissection
    • Appendicitis
    • Asthma
    • Backpain
    • Bowel Obstruction
    • Bronchiectasis
    • Burns
    • Chest Pain >
      • ADP Chest Pain Pathway
    • Cholecystitis
    • Confusion
    • COPD
    • Diverticulitis
    • DKA
    • DVT
    • Eating Disorders
    • Febrile Neutropaenia
    • Fractures >
      • Bier's block procedure form
      • Fractured neck of Femur
    • Funnel Web Spider Bite
    • Headache
    • Influenza Like illness
    • Meningitis
    • Obstetrics >
      • Hypertensive disorders in pregnancy
      • Normal Birth
      • PPH
      • Preterm labour
      • Still birth
      • Trauma in pregnancy
    • Pancreatitis
    • Paracetamol OD
    • Pathology Ordering
    • Peri-anal abscess
    • Pertussis
    • Pneumonia
    • Pneumothorax
    • Podiatry
    • Procedural Sedation >
      • Procedural Sedation
    • Pulmonary Embolus
    • PV Bleeding in Early pregnancy >
      • EPAU - Early Pregnancy Assessment Unit
    • Redback Spider Bite
    • Ring cutter use
    • Seizure
    • Septic Arthritis
    • Use of Restraints
    • Stroke / TIA
    • Sepsis
    • Smoking cessation
    • Snake Bite
    • Syncope >
      • Telemetry guideline
    • TIA
    • Tonometer use
    • Antidotes
    • Dagibatran reversal guidelines
    • Funnel Web Spider Bite
    • Redback Spider Bite
    • Paracetamol OD
    • Snake Bite
    • Warfarin Reversal Guidelines
    • Trauma >
      • C-spine injury
      • Head Injury
      • Imaging Guidelines
      • Trauma in pregnancy
      • Sutures
    • Abdominal Pain
    • Allergy / Anaphylaxis
    • Antimicrobial Guidelines
    • Asthma & Wheeze
    • Behavioural Disturbance
    • Boils - Staph decolonisation treatment
    • Bronchiolitis
    • Buckle fractures
    • Burns
    • Cervical Spine Guideline
    • Chest Pain (Paediatric)
    • Child Protection
    • Constipation
    • Croup
    • DKA
    • Drowning
    • Eating Disorders
    • Fever
    • Fluids in Kids
    • Foreign Bodies
    • Gastroenteritis
    • Headache
    • Head Injury
    • High Flow Nasal Cannula Oxygen
    • Hypoglycaemia
    • Jaundiced Neonate
    • Limping in children
    • Malaria
    • Meningitis
    • Oncology Emergencies
    • Otitis Externa
    • Otitis Media
    • Paediatric Fracture Clinic Referral
    • Paracetamol Poisoning
    • Petechial Rash
    • Pneumonia (CAP)
    • Seizures / Status Epilepticus
    • Sepsis Guideline
    • Tetanus Prophylaxis
    • Torticollis
    • UTI NICE Guideline
    • Trauma in children >
      • LCCH Paeds Trauma Guidelines
      • C Spine Injury LCCH Guideline
      • LCCH Massive Transfusion
    • RCH Melbourne Guidelines
  • Parent Handouts
    • Accidental Poisoning
    • Abdominal Pain
    • Ankle Sprain
    • Arrhythmia
    • Asthma
    • Bronchiolitis
    • Chest Infections
    • Cast Care
    • Cellulitis
    • Constipation
    • Croup
    • DKA
    • Epistaxis
    • Eye Foreign Body
    • Febrile Convulsion
    • Fever
    • Fracture- Buckle
    • Fracture- Clavicle
    • Fracture- Elbow
    • Fracture- Finger/Toe
    • Fracture- Foot
    • Gatroenteritis
    • Glue- Lacerations
    • Head Injury
    • Jaundice
    • Otitis Externa
    • Parechovirus
    • Periorbital and Orbital cellulitis
    • Pulled Elbow
    • Seizures
    • Tonsillitis
    • Urticaria
    • Viral Illness
    • Wound Care
  • ACE the ACEM
  • Blog