Unwell ward patient with a rising early warning score
PLAB 2 practice station

The task

You are the foundation doctor covering a surgical ward at night. It is 22:00. Staff Nurse Sunita Pillai asks you to review Mr Leroy Grant, aged 68, who is on day 3 after an emergency hernia repair. His observation chart shows rising scores over the past six hours. Assess him, start treatment, and speak to the senior doctor on call by telephone to hand over and agree a plan. The nurse is with you. You may ask the nurse to carry out tasks. The examiner will not take part in the conversation.

What this station tests

• Use ABCDE and calculate NEWS2 correctly; a score of 7 or more needs an emergency response.
• In suspected sepsis with a NEWS2 of 7 or more, give broad-spectrum intravenous antibiotics and a fluid bolus within 1 hour and check lactate.
• Look for the source and for organ dysfunction (urine output, lactate, blood pressure).
• Use SBAR, ask for a plan and agree when to call 2222.
• Talk to the patient and relatives; fear of deterioration is common.

Sources for the clinical content

• NICE NG253: Suspected sepsis in people aged 16 or over: recognition, assessment and early management
• Royal College of Physicians: National Early Warning Score (NEWS) 2

An original practice scenario with invented patients. Not an exam question.

Practise next

• Sudden breathlessness and itching after an infusion
• Vomiting blood in the emergency department
• Wheezy and breathless young woman
• Confused and sweaty patient on the ward