Case 1
You are seeing Herbert Jones, a 88 yo man who was admitted one week ago for pneumonia, altered mental status, and weakness. The day after admission he developed chest pain, with a mildly positive troponin, though no ST changes. He was brought to the ICU for three days. Because of his poor condition he did not elect to pursue angiogram. He was transferred back to the medicine floor under you yesterday.
Today you find him more restless, confused, and short of breath. He is on two L of oxygen, though is satting 84%. This morning he had been 96% with 2L. His pulse is 114, BP is 112/88, and respiratory rate is 26. He is working hard to breathe. You listen to his lungs, and while it is a difficult exam, you think you hear fine crackles bilaterally.
Because of your concern, you decide to call for help. What do you say?
Case 2
You are caring for Betty White, a 68 yo woman admitted last night for pancreatitis. She was doing reasonably well with IV fluids and pain control. The cause is unclear, but there is suspicion that she drank heavily. She is under the care of the hospitalist.
As you check on her first thing in the morning, you find her restless and confused. This is a significant change in her condition. Her pulse is 120, BP is 110/60, temp is 37.8C, RR is 20, and her sats are 96% on RA.
Because of your concern, you decide to call for help. What do you say?
Notes
These cases are designed for practicing urgent oral communication, especially using the SBAR format. This is described here.