The calls that actually come in out of hours, each with a plan you can read on the way to see the patient. Written for FY1s covering the wards overnight.
The delirious / agitated patient overnightUsually called because a patient is climbing out of bed, pulling lines, shouting, hallucinating or striking out. The job is to keep everyone safe, find the immediate cause,… Patient wants to self-discharge"They're getting dressed and saying they're going home." Two jobs, in this order: find out why they want to leave, because most of these are solvable, and then decide whether… Post-fall assessmentYou're bleeped that a patient has been found on the floor. This will happen at any time but generally peak time is 6-8am when patients start getting up, sometimes this will be… The dying patient overnightThis situation broadly falls into one of two categories. ① the patient is expected to die and has a very clear plan in place, has been seen by palliative care, and perhaps… Talking to families overnightUsually called because relatives want an update, are worried the patient is worse, or were promised a conversation that never happened. You often do not know the patient or… Verifying a deathYou will be called because a patient has died and nursing staff need formal verification. First establish whether the death was expected and whether CPR should have been… Blocked / difficult / blood-stained catheterUsually called because a catheter has stopped draining, is bypassing, will not pass, or contains blood. The job is to relieve painful retention, avoid urethral trauma and… Low urine output and retentionYou'll be called because the catheter bag looks empty, the fluid chart has a run of small hourly volumes, or the patient cannot pass urine ± pain. One question splits the whole… ConstipationA common overnight bleep. Usually benign and fixable, but exclude obstruction and faecal Patient spiking a feverUsually called because a ward patient has developed a new fever. The job is to decide how sick they are, find the likely source and send useful cultures. Hypotension overnightUsually called because a BP is low overnight. Most of the time this is not a concern and in fact a normal finding during sleep, however, once noted it becomes necessary to repeat… New oxygen requirementUsually called because sats have fallen or oxygen has been started/increased. First confirm the reading, make sure it isn't being taken from a cold poorly perfused finger, then… Hyperglycaemia on callUsually called because a CBG is high, often this is a patient not known to you. Do not reflexively give stat NovoRapid: first decide whether the patient is unwell,… Asked to write up fluidsThis usually arrives as a job rather than a clinical question — "can you write up some fluids for bed 12". Before you write anything, decide whether they need IV fluids at all,… Asked for something for painThe commonest bleep of the night, and it arrives as a task — "can you write something up for the pain in bed 9" or "can this patient have paracetamol please". The only question… Nausea and vomiting on callUsually a request for "something for sickness", and usually reasonable, it's a very unpleasant symptom. The two things worth five minutes of your time first: is the abdomen…Emergency checklists, ward cover and on-call scenarios, and clerking plans for the medical take — an app for resident doctors, working offline on the ward.
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