{"id":5371,"date":"2011-07-14T20:25:54","date_gmt":"2011-07-14T20:25:54","guid":{"rendered":"http:\/\/crashtext.org\/misc\/5371.htm\/"},"modified":"2012-07-25T19:04:52","modified_gmt":"2012-07-25T23:04:52","slug":"rapid-response-teams","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/intensive-care\/rapid-response-teams.htm\/","title":{"rendered":"Rapid Response Teams (MERT, RRT)"},"content":{"rendered":"<h2>Med Emerg Response Teams<\/h2>\n<p>&nbsp;<\/p>\n<p>crit care 2006;10:121 and R30<\/p>\n<p>&nbsp;<\/p>\n<p>Table 1:\u00a0 Calling Criteria for Medical Emergency Teams<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>Staff member is worried about the patient<\/li>\n<li>Airway\n<ul>\n<li>Noisy breathing \/ stridor<\/li>\n<\/ul>\n<\/li>\n<li>Breathing\n<ul>\n<li>Acute change in respiratory rate to &lt; 8 or &gt; 30 breaths \/ min<\/li>\n<li>Acute change in pulse oximetry saturation to &lt; 90% despite oxygen administration<\/li>\n<\/ul>\n<\/li>\n<li>Circulation\n<ul>\n<li>Acute change in heart rate to &lt; 40 or &gt; 130 beats \/ min<\/li>\n<li>Ischemic chest pain \u00b6<\/li>\n<li>Acute change in systolic blood pressure to &lt; 90 mmHg<\/li>\n<li>Acute change in urinary output to &lt; 50 mL in 4 hrs.<\/li>\n<\/ul>\n<\/li>\n<li>Conscious state\n<ul>\n<li>Acute change in conscious state<\/li>\n<li>Multiple seizures\u00b6<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>\u00b6 Indicates criteria specific for The Northern Hospital<br \/>\n<strong> Table 2:\u00a0 Common reasons for MET calls at The Austin Hospital<\/strong><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong> Cause of the MET call<\/strong><\/p>\n<p><strong> Number of calls<\/strong><\/p>\n<p><strong> Hypoxia \/ Increased respiratory rate<\/strong><\/p>\n<p>Pulmonary oedema \/ fluid overload<\/p>\n<p>Pneumonia \/ aspiration<\/p>\n<p>Exacerbation chronic obstructive airways disease<\/p>\n<p>Sepsis<\/p>\n<p>Pulmonary embolism<\/p>\n<p>Arrhythmia<\/p>\n<p>Sputum plug, narcotized, acidemia, pleural effusion, tracheostomy blocked, atelectasis, intracranial event<\/p>\n<p>No cause documented<\/p>\n<p><strong> 218<\/strong><\/p>\n<p>66<\/p>\n<p>52<\/p>\n<p>16<\/p>\n<p>11<\/p>\n<p>11<\/p>\n<p>12<\/p>\n<p>30<\/p>\n<p>&nbsp;<\/p>\n<p>20<\/p>\n<p><strong> Hypotension<\/strong><\/p>\n<p>Sepsis<\/p>\n<p>Bleeding \/ hypovolemia<\/p>\n<p>Acute pulmonary oedema \/ myocardial ischemia<\/p>\n<p>Arrhythmia<\/p>\n<p>Cardiac arrest<\/p>\n<p>Epidural related, Pulmonary embolism, anaphylaxis, vasovagal, Narcosis<\/p>\n<p>No cause documented<\/p>\n<p><strong> 112<\/strong><\/p>\n<p>30<\/p>\n<p>28<\/p>\n<p>15<\/p>\n<p>10<\/p>\n<p>4<\/p>\n<p>13<\/p>\n<p>&nbsp;<\/p>\n<p>15<\/p>\n<p><strong> Altered conscious state<\/strong><\/p>\n<p>Sepsis<\/p>\n<p>Stroke \/ Transient ischemic attach or Intracranial bleed<\/p>\n<p>Seizure<\/p>\n<p>Hypovolemia<\/p>\n<p>Cardiogenic shock \/ acute coronary syndrome<\/p>\n<p>Drug related<\/p>\n<p>CO2 narcosis<\/p>\n<p>Vasovagal, arrhythmia, cardiac arrest, encephalopathy, uremia, meningitis<\/p>\n<p>No cause documented<\/p>\n<p><strong> 93<\/strong><\/p>\n<p>13<\/p>\n<p>13<\/p>\n<p>11<\/p>\n<p>8<\/p>\n<p>6<\/p>\n<p>5<\/p>\n<p>5<\/p>\n<p>21<\/p>\n<p>&nbsp;<\/p>\n<p>12<\/p>\n<p><strong> Tachcyardia<\/strong><\/p>\n<p>Arrhythmia<\/p>\n<p>Sepsis<\/p>\n<p>Acute pulmonary oedema \/ myocardial ischemia<\/p>\n<p>Drug related<\/p>\n<p>Hypovolemia<\/p>\n<p>Respiratory distress<\/p>\n<p>Pulmonary embolism, Epidural related, stroke<\/p>\n<p>No cause documented<\/p>\n<p><strong> 77<\/strong><\/p>\n<p>29<\/p>\n<p>13<\/p>\n<p>10<\/p>\n<p>4<\/p>\n<p>3<\/p>\n<p>3<\/p>\n<p>3<\/p>\n<p>11<\/p>\n<p><strong> Oliguria<\/strong><\/p>\n<p>Sepsis<\/p>\n<p>Cardiogenic shock<\/p>\n<p>Hypovolemia<\/p>\n<p>Urinary tract obstruction<\/p>\n<p>Drug related, hepatorenal syndrome, stroke<\/p>\n<p>No cause documented<\/p>\n<p><strong> 31<\/strong><\/p>\n<p>7<\/p>\n<p>7<\/p>\n<p>4<\/p>\n<p>2<\/p>\n<p>5<\/p>\n<p>3<\/p>\n<p>&nbsp;<\/p>\n<p><strong><br \/>\n<\/strong><\/p>\n<p><strong> Table 3:\u00a0 Proposed minimum criteria for managing a MET call<\/strong><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>Determine the etiology of the deterioration<\/li>\n<li>Document the events surrounding the MET call<\/li>\n<\/ul>\n<p>(A pre-formatted fluorescent yellow sticker is used at The Austin Hospital)<\/p>\n<ul>\n<li>Organize a management plan and appropriate medical follow-up<\/li>\n<li>Automatic medical referral for surgical patient subject to a MET call for a medical reason in cases where the patient remains on the ward\u00b6<\/li>\n<li>Communicating with the parent unit (or their cover) that the MET has occurred<\/li>\n<li>Compulsory review of the patient by an Intensivist for a patient requiring two MET reviews in a seven day period \u00b6<\/li>\n<li>Communicating with the intensivist if the following criteria are fulfilled:\n<ul>\n<li>The patient remains unstable following initial resuscitation<\/li>\n<li>The patient requires ICU or HDU admission<\/li>\n<li>The patient may require ICU or HDU admission in the future<\/li>\n<li>The patient has been admitted to ICU or HDU during this hospital admission<\/li>\n<li>The members of the MET are unsure how to manage the patient (i.e. the members of the MET are worried about the patient).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>\u00b6 Criteria specific for Austin Hospital.<\/p>\n<p>&nbsp;<\/p>\n<p>MET, Medical Emergency Team; ICU, Intensive Care Unit; HDU, High Dependency Unit.<\/p>\n<p>&nbsp;<br \/>\n<strong> Table 4: An approach to managing a MET call<\/strong><\/p>\n<p><strong> \u00a0<\/strong><\/p>\n<p><strong> A<\/strong>sk and <strong>A<\/strong>ssess<\/p>\n<p><strong>A<\/strong>sk the staff how you can help them<strong>A<\/strong>sk about the reason for the MET call<\/p>\n<p><strong>A<\/strong>ssess for the etiology of the deterioration<\/p>\n<p>&nbsp;<\/p>\n<p><strong> B<\/strong>egin<strong> b<\/strong>asic investigations and resuscitation therapy<\/p>\n<p>&nbsp;<\/p>\n<p><strong> C<\/strong>all for help \/ <strong>c<\/strong>all consultant if needed<\/p>\n<p>&nbsp;<\/p>\n<p><strong> D<\/strong>iscuss, <strong>D<\/strong>ecide, and <strong>D<\/strong>ocument<\/p>\n<p><strong>D<\/strong>iscuss MET with parent unit \/ consultant<\/p>\n<p><strong>D<\/strong>iscuss advanced care planning if appropriated<\/p>\n<p><strong>D<\/strong>ecide where the patient needs to be managed<\/p>\n<p><strong>D<\/strong>ocument the MET and subsequent frequency of observations<\/p>\n<p>&nbsp;<\/p>\n<p><strong> E<\/strong>xplain: the cause of the MET, the investigations required and subsequent management plan<\/p>\n<p>&nbsp;<\/p>\n<p><strong> F<\/strong>ollow-up: which doctor to follow-up the patient?\u00a0 What are the criteria for doctor re-notification?<\/p>\n<p>&nbsp;<\/p>\n<p><strong> G<\/strong>raciously thank the staff at the MET<\/p>\n<p>&nbsp;<br \/>\n<strong> Table 5:\u00a0 Management of the \u0093Hypoxic \u0096 tachypneic MET call\u0094<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>A<\/strong>ssess for etiology<\/p>\n<ul>\n<li>Pulmonary edema \/ Cardiac failure (Past history of heart disease.\u00a0 Current evidence of myocardial ischemia, raised JVP, oedema, bilateral crepitations, cardiomegaly)<\/li>\n<li>Dependent atelectasis\/collapse (Patient immobile, basal chest signs, recent surgery)<\/li>\n<li>Asthma \/ COAD (Wheeze, prolonged expiration, hyper-inflated chest)<\/li>\n<li>Sepsis anywhere.\u00a0\u00a0 eg lung, kidney, wound, intra-abdominal.<\/li>\n<li>Pulmonary embolism \u0096 immobile, recent surgery, history of thrombo-embolism, tachycardia, ECG changes of right ventricular strain<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>B<\/strong>egin <strong>b<\/strong>asic investigations and resuscitation<\/p>\n<ul>\n<li>Administer oxygen and obtain portable CXR<\/li>\n<li>ECG, Cardiac enzymes, electrolytes<\/li>\n<li>Sepsis screen: FBE, CRP, blood, urine, sputum, wound.<\/li>\n<li>Consider ABG +\/- lactate<\/li>\n<li>Pulmonary edema \u0096 <strong> L<\/strong>oop diuretic, <strong>m<\/strong>orphine, <strong>n<\/strong>itrates<strong>, o<\/strong>xygen<strong>, p<\/strong>osture, consider CPAP<\/li>\n<li>Dependent atelectasis\/collapse \u0096 chest physiotherapy, humidified oxygen<\/li>\n<li>Asthma \/ COAD \u0096 bronchodilators, steroids, antibiotics ?BiPAP.<\/li>\n<li>Pulmonary embolism \u0096 V\/Q scan or CTPA.\u00a0 Consider anti-coagulation.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>C<\/strong>all for help<\/p>\n<ul>\n<li>SaO2 &lt; 90% despite 10L inspired oxygen<\/li>\n<li>RR &gt; 40, elevated PaCO2, altered conscious state<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>D<\/strong>iscuss &amp; <strong>D<\/strong>ecide<\/p>\n<ul>\n<li>Is the patient stable or unstable?<\/li>\n<li>What is the management plan?<\/li>\n<li>Does the patient need ICU\/HDU\/surgery?<\/li>\n<li>Communicate with patient\/Next of kin\/parent unit\/Intensivist<\/li>\n<li>What is the subsequent follow up plan?<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>E<\/strong>xplain<\/p>\n<ul>\n<li>Cause of the hypoxia and subsequent management plan.<\/li>\n<li>Subsequent observations required.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>F<\/strong>ollow-up<\/p>\n<ul>\n<li>Who will follow-up the patient?<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>JVP = jugular venous pressure, COAD = chronic obstructive airways disease, WCC = white cell count, ECG = electrocardiogram, CXR = chest X-ray, ABG = arterial blood gas, FBE = full blood examination, CRP = C-reactive protein, V\/Q = ventilation perfusion, CTPA = CT pulmonary angiogram, SaO2 = saturation oxygen, RR = respiratory rate, PaCO2\u00ad = partial pressure of carbon dioxide, ICU = Intensive Care Unit, HDU = High dependency Unit.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>crit care 2006;10:R30<\/p>\n<p>&nbsp;<\/p>\n<p>Full annotated bibliography (Crit Care Med 2006;34:2463)<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>|\u00a0\u00a0 \u00a0\u00a0 |\u00a0\u00a0 \u00a0\u00a0 |<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Array<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[18],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Rapid Response Teams (MERT, RRT) - Crashing Patient<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/crashingpatient.com\/intensive-care\/rapid-response-teams.htm\/\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"CrashMaster\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/crashingpatient.com\/intensive-care\/rapid-response-teams.htm\/\",\"url\":\"https:\/\/crashingpatient.com\/intensive-care\/rapid-response-teams.htm\/\",\"name\":\"Rapid Response Teams (MERT, RRT) - Crashing Patient\",\"isPartOf\":{\"@id\":\"https:\/\/crashingpatient.com\/#website\"},\"datePublished\":\"2011-07-14T20:25:54+00:00\",\"dateModified\":\"2012-07-25T23:04:52+00:00\",\"author\":{\"@id\":\"https:\/\/crashingpatient.com\/#\/schema\/person\/68373c312014141023ba30948675be1d\"},\"breadcrumb\":{\"@id\":\"https:\/\/crashingpatient.com\/intensive-care\/rapid-response-teams.htm\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/crashingpatient.com\/intensive-care\/rapid-response-teams.htm\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/crashingpatient.com\/intensive-care\/rapid-response-teams.htm\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/crashingpatient.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Rapid Response Teams (MERT, RRT)\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/crashingpatient.com\/#website\",\"url\":\"https:\/\/crashingpatient.com\/\",\"name\":\"Crashing Patient\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/crashingpatient.com\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/crashingpatient.com\/#\/schema\/person\/68373c312014141023ba30948675be1d\",\"name\":\"CrashMaster\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/crashingpatient.com\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/df72275d57de87ddb0cfafc82b66d544?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/df72275d57de87ddb0cfafc82b66d544?s=96&d=mm&r=g\",\"caption\":\"CrashMaster\"},\"url\":\"https:\/\/crashingpatient.com\/author\/emcrit\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Rapid Response Teams (MERT, RRT) - Crashing Patient","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/crashingpatient.com\/intensive-care\/rapid-response-teams.htm\/","twitter_misc":{"Written by":"CrashMaster","Est. reading time":"4 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/crashingpatient.com\/intensive-care\/rapid-response-teams.htm\/","url":"https:\/\/crashingpatient.com\/intensive-care\/rapid-response-teams.htm\/","name":"Rapid Response Teams (MERT, RRT) - Crashing Patient","isPartOf":{"@id":"https:\/\/crashingpatient.com\/#website"},"datePublished":"2011-07-14T20:25:54+00:00","dateModified":"2012-07-25T23:04:52+00:00","author":{"@id":"https:\/\/crashingpatient.com\/#\/schema\/person\/68373c312014141023ba30948675be1d"},"breadcrumb":{"@id":"https:\/\/crashingpatient.com\/intensive-care\/rapid-response-teams.htm\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/crashingpatient.com\/intensive-care\/rapid-response-teams.htm\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/crashingpatient.com\/intensive-care\/rapid-response-teams.htm\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/crashingpatient.com\/"},{"@type":"ListItem","position":2,"name":"Rapid Response Teams (MERT, RRT)"}]},{"@type":"WebSite","@id":"https:\/\/crashingpatient.com\/#website","url":"https:\/\/crashingpatient.com\/","name":"Crashing Patient","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/crashingpatient.com\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/crashingpatient.com\/#\/schema\/person\/68373c312014141023ba30948675be1d","name":"CrashMaster","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/crashingpatient.com\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/df72275d57de87ddb0cfafc82b66d544?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/df72275d57de87ddb0cfafc82b66d544?s=96&d=mm&r=g","caption":"CrashMaster"},"url":"https:\/\/crashingpatient.com\/author\/emcrit\/"}]}},"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/posts\/5371"}],"collection":[{"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/comments?post=5371"}],"version-history":[{"count":0,"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/posts\/5371\/revisions"}],"wp:attachment":[{"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/media?parent=5371"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/categories?post=5371"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/tags?post=5371"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}