14 Urgent Situations and Coordinated Care
Learn to recognize patient deterioration, respond to urgent threats, communicate clearly, and coordinate care during emergencies and disasters.
Recognizing deterioration
A patient may worsen before a crisis is obvious. Compare current findings with the patient’s baseline and watch for new changes, concerning trends, or a mismatch between the patient’s appearance and recorded measurements.
Warning signs include:
New confusion, reduced responsiveness, agitation, or fainting.
Increased work of breathing, abnormal breathing, or falling oxygen saturation.
A sudden change in pulse or blood pressure, pale or clammy skin, or uncontrolled bleeding.
New severe pain, weakness on one side, difficulty speaking, or other sudden neurologic changes.
Markedly reduced urine output or a rapid overall decline.
Responding to urgent threats
Protect safety, summon help, and address life threats first. Use the facility’s response process and work within your role.
Stay with the patient and assess immediate threats. Check responsiveness, airway, breathing, circulation, and vital signs as appropriate to the situation and your training.
Call for help early. Activate the rapid response team or equivalent under facility criteria when a patient is seriously worsening. If the patient is unresponsive and not breathing normally, activate the emergency response or code system.
Begin immediate care within your training, , and facility protocol. Do not delay an emergency call to complete a full assessment or reach a particular clinician.
Continue to observe and reassess. Report changes and the patient’s response to actions taken, and document facts and times according to policy.
Specific urgent threats
Possible cardiac arrest: For an unresponsive adult with absent or abnormal breathing, a healthcare professional checks for a pulse for no more than seconds. If no definite pulse is felt, assume cardiac arrest, activate the emergency response, and begin CPR. Use an AED as soon as available, following training and local protocol.
Possible stroke: Sudden balance or vision changes, facial droop, arm weakness, or speech difficulty require immediate escalation. Note when the person was last known well; do not wait to see if symptoms pass.
Other sudden deterioration: Report the specific change, relevant measurements, when it began, and what has already been done. Follow emergency-team direction and maintain observation until care is handed over.
Communicating under pressure
Use to organize an urgent report:
Situation: Identify who you are, where you are, and what is happening now.
Background: Provide relevant history, recent changes, and current treatment.
Assessment: Describe what you observe and measure, including trends.
Recommendation/request: State what help or immediate action is needed.
Use call-outs for critical information and for assigned tasks: the receiver repeats the instruction, and the sender confirms it. These practices reduce the chance that a key message or task is missed.
Coordinating disaster response
A disaster can create more urgent needs than available staff, space, or supplies. Priorities and triage may therefore differ from routine care of one patient at a time. Follow the facility emergency plan, supervisor instructions, and incident-command structure; do not improvise a separate response.
Protect yourself and others: Observe hazard warnings, use required protective equipment, and do not enter an unsafe area. Follow instructions for isolation, evacuation, sheltering, or decontamination.
Report and organize: Know your assigned role, reporting line, and designated work area. Use approved communication channels and preserve patient identification and documentation procedures.
Triage and reassess: Use the triage system directed by the incident plan. One U.S. mass-casualty method is —Sort, Assess, Lifesaving Interventions, Treatment/Transport—which prioritizes patients according to immediate threats and available resources. Reassess as conditions change and follow local policy.
Support continuity of care: Communicate patient status, critical needs, and transfer or disposition information to the receiving team. Attend to communication, mobility, medication, and other support needs of people who may require additional assistance.
Team roles and practical nursing
Safe emergency care depends on timely teamwork among nursing staff, providers, respiratory therapists, pharmacists, emergency responders, and others. Share relevant observations promptly, request assistance when needed, and clarify unclear instructions. If a concern is not addressed, restate it and use the chain of command or emergency activation process.
Practical nurses contribute through observation, timely reporting, care within their competence, and participation in the team’s response. and delegation rules vary by state and setting. Follow the applicable nurse practice act, employer policy, and direction from the responsible licensed nurse; do not accept a task outside your authorized role or competence.
Putting coordinated care into practice
If a patient becomes newly confused and increasingly short of breath, stay with the patient, obtain immediate observations and vital signs within your role, and activate the facility’s rapid response process. Give an report, ask a colleague to bring needed equipment, and repeat back assigned actions to confirm them. The team then reassesses the patient and communicates any change in condition.
Across urgent situations, recognize meaningful changes early, assess immediate threats, and call for help without delay. Begin only care within your training and , reassess the patient, and communicate observations and actions clearly. In disasters, protect safety, follow incident command and local triage procedures, and coordinate care as a team.