Deterioration Watch: Trends, Labs and the SBAR Call
Single vital signs are weak evidence; trends are strong evidence, and most patients who arrest on a medical-surgical unit show deranged numbers for six to eight hours first. Watch a patient move set by set and decide when to escalate, interpret the laboratory values that force a decision, then build the call itself — because the quality of your communication determines the speed of the response.
Choose a patient
Set
—
1 of 5 recorded
Parameter
Value
Reading
Interpret a laboratory value
Build the escalation call
Mr. Lin, room 412. Post-operative day two from a right hemicolectomy. Over three hours his respiratory rate has climbed from 18 to 30 and his SpO₂ is 88 percent on 4 L by nasal cannula. Heart rate 122, blood pressure 96/58, lungs clear, right calf swollen and tender. He has a history of atrial fibrillation and his enoxaparin was held yesterday for a procedure. You have already increased his oxygen and raised the head of the bed. Sort every sentence below into S, B, A or R — or leave it out of the call.
The reading
Advance the patient set by set on the left. Escalate the moment you believe the trend has declared itself.