Cross-cover

You are covering 40 medical beds overnight. Four pages arrive within five minutes. Put the pages in the order you would answer them in person, then commit.

1. 1 · Patient D: new oxygen requirement

   "Bed 9, post-op day 1 hip, sats 89 percent on air. She was 95 percent at handover. RR 26, HR 104, no chest pain, a bit anxious."

2. 2 · Patient C: pain medication request

   "Bed 22 wants more analgesia for his back. He had oxycodone at 20:00. Nothing else charted."

3. 3 · Patient B: low blood pressure

   "Bed 3, the cirrhotic with the GI bleed from last night: BP 84/46, from 110/70 at 20:00. HR 118. He is pale and a bit vague."

4. 4 · Patient A: new fever

   "Bed 14, day 2 of pyelonephritis on ceftriaxone, temperature 38.6. She looks fine, asking for a blanket. HR 92, BP 124/76."

The quiet part of the night. Four pages in ten minutes. Put the pages in the order you would answer them in person, then commit.

1. 1 · Patient B: chest pain

   "Bed 11, 66-year-old admitted with heart failure, has central chest pain for 20 minutes, sweaty. HR 96, BP 136/84."

2. 2 · Patient C: a potassium of 6.1

   "The lab just phoned a potassium of 6.1 on bed 18, the CKD patient. Repeat sample? She is asleep."

3. 3 · Patient A: confused and pulling at lines

   "Bed 6, the 81-year-old with pneumonia, is trying to climb out of bed and has pulled out his cannula. He was fine at midnight. Sats 93 on 2 L."

4. 4 · Patient D: a fall

   "Bed 2 was found on the floor by the bathroom. No obvious injury, says she slipped. She is back in bed. Vitals normal. She is on warfarin."