Setting the scene
In Hospital:
At 5:30AM– JoySmith, a 70 year old lady was brought in by her husband, John, toED as she had
becomeagitated, confused, andfatigued. Johnhasnoticedonthelast 3days that Joyhas losther
she normally does.Today at 4:30AM, Joywoke upwith chills and was agitated saying she did not
know where she was. The couple live by themselves and are both retired and independent with ADLs.
In triage, Joy was confused to time and place. The triage nurse reoriented Joy to where she was, why
she was in hospital and continued assessing her. Joy’s vital signs were RR 26, SpO2 94% on RA, BP
95/55 mmHg, HR 105, T 38.3 ?. The triage nurse asked Joy if she had any pain or discomfort, and Joy
stated she has recently had a stinging sensation when passing urine. She was triaged ATScategory 3.
left TKR in 2010. Medication: Carvedilol 50mg BD, Aspirin 100mg daily in the morning, Lipitor 40mg
daily in the evening, andPanadol Osteo – 2 tablets TDS. NKA. She weighs 88 kg.
At 6:00AM –Joy was transferred by wheel chairto theacute care bed(red area inED).She was placed
in a gown and covered with a sheet and one blanket. On examination, airway patent, she was talking
infullsentences.Sheappears slightlybreathlessusingaccessorymusclesoninspiration,RR27,SpO2
93%,onauscultationtherewasdecreasedairentry inbothbases,nilcyanosisperipherallyorcentrally.
BP90/55 mmHg, HR 116 regular and weak. RMO has ordered a full blood set (FBC EUC, CRP, LFTs,
coags and glucose), and a venous blood gas. Bloods were collected, 18 gauge cannula insitu located
on the right posteriorforearm. Joy’s orientation was fluctuating, at this point she was confused to
place GCS 14 (Eyes=4, Verbal=4, Motor=6). She rated a pain score of 3/10 when passing urine, T 38.3?,



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