Week 7 - Emergency Response & Escalation

Define a deteriorating patient

Someone who has a sudden or gradual decline in their physiological or psychological state.

List the 3 systems/symptoms whose decline require immediate emergency care.

• Respiratory system

• Cardiovascular system

• Level of consciousness

Explain why it is more difficult for MRPs to detect signs of a deteriorating patient compared to a nurse

Imaging departments are much more high risk as there is limited monitoring of the patient and physical separation from patients in the procedure room during a scan.

State the Domain within the MRPBA Professional Capabilities 2026 that outlines the role of MRPs in managing a deteriorating patient

Domain 1.1h

State when this change to MRPBAs Professional Capabilities had come into effect

30th March 2026

Explain an MRPs responsibilities that are outlined Domain 1.1h

• Recognise a deteriorating patient, including events such as anaphylaxis

• Respond in an appropriate and timely manner

• Call for help and document actions

State the additional training requirements for MRPBAs since this change to professional capabilities

• Completion of HLTAID010 - Provide Basic ELS

• Regular refresher courses to maintain skills

Name and explain the 3 ways that adrenaline can be administered for anaphylaxis

• Autoinjectors - easy administration for anyone in the community, eg. EpiPen or Anapen

• Pre-filled Syringes - fast administration for health professionals

• Ampoules - for trained health professionals who have to draw up dose before injection

State the difference scope for anaphylaxis in different states within Australia

• Queensland and Tasmania - MRPs restricted to use of autoinjectors or pre-filled syringes only

• All other states - MRPs can use autoinjectors, pre-filled syringes and ampoules.

State the symptoms that indicate anaphylaxis

• Airway compromise, eg. tongue and throat swelling

• Skin changes, eg. Rash, redness, swelling etc.

• Hypotension

• Breathing difficulties

Explain the Choosing Wisely Australia initiative

An initiative that encourages health professionals to question the necessity of tests, treatments and procedures to reduce patients exposure to harm and prevent waste of time, cost and resources.

Name the 3 early vital signs of patient deterioration

• Tachycardia

• Tachypnea

• Hypoxia

Name the 2 overall categories for soft signs of patient deterioration

• Behavioural changes

• Physical changes

List soft behavioural changes

• Confused

• Withdrawn

• Drowsy

• Less responsive

List the soft physical changes

• Increased sleeping

• Lethargy

• Reduced mobility

State normal body temperature

36-37.5 degrees Celsius

State normal heart rate

60-100 BPM

State normal respiratory rate

12-20 breaths/min

State normal oxygen saturation

Greater than or equal to 95%

State normal systolic BP

100-180mmHg

State and briefly explain how a patients level of consciousness is assessed

• A - alert (patient is awake and alert)

• V - voice (patient responds to verbal stimuli)

• P - pain (patient only responds to painful stimuli)

• U - unresponsive (patient does not respond to any stimuli)

List the 7 major causes of patient deterioration

• Respiratory

• Cardiovascular

• Infection

• Neurological

• Metabolic/Endocrine

• Latrogenic/medical/procedural

• Anaphylaxis/Allergic Responses

Name the common causes of respiratory compromise

• Airway obstruction

• Bronchospasm

• Pulmonary embolism

• Pneumonia/pulmonary oedema

Name the red flags of respiratory compromise

• Difficulty speaking

• Tachypnea/bradypnea

• Use of accessory muscles

• Cyanosis

Name the common causes of cardiovascular instability

• Shock

• Arrhythmia

• Myocardial infarction

Name the red flags of cardiovascular instability

• Systolic BP > 90mmHg

• Dizzy/light-headed

• Tachy/bradycardia

• Chest pain

• Pale and sweaty

State the common causes of neurological deterioration

• Stoke

• Seizure

• Rescued consciousness

State the red fags that indicate neurological deterioration

• Dizziness/loss of balance

• Loss of senses

• Failure to follow instructions

• Confused/drowsy

State the common causes of anaphylaxis/allergic reactions

• Iodinated contrast

• NM RPs

State the most common causes of metabolic/endocrine deterioration

• Hypoglycaemia from fasting before scans

• Electrolytes imbalance

• Dehydration

State the red flags that indicate metabolic/endocrine deterioration

• Excessive sweating

• Shaky

• Confused

• Ketoacidosis

State the common causes of infection

• Post-surgery

• Immunocompromised patients

Define sepsis

A medical emergency in response to severe infection that causes multiple organ failure.

State latrogenic/medical/procedural complications

• Sedation/anaesthetics

• Opioids

• Contrast extravasation

• IV complications/bleeding

State other clinical red flags reported by patients

• Pain

• Sense of impending doom

Expand the DRSABCD acronym for ELS

• D - scan for danger

• R - check for patients response

• S - send for help and defibrillator

• A - check airways

• B - check breathing

• C - if no breathing, start CPR

• D - use defibrillator ASAP

List common hazards

• Sharps

• Bodily fluids

• Spills

• Aggressive/distressed patients

• Radiation exposure

Explain the criteria for completing CPR

• 30 compression and 2 breaths

• Heel of hand placed on lower half of breast bone

• Compress to 1/3 of chest depth

• 100-120 compressions/min

State the 2 communication frameworks used in emergency situations

• ISBAR

• Closed-Loop

Explain the ISBAR communication framework

Exchange this essential information:

• Introduction

• Situation

• Background

• Assessment

• Recommendation/response

Explain the closed-loop communication framework

Asking for the person to repeat back the information you’ve given to confirm it was received and properly understood.

State the 3 advocacy and assertion tools in emergency situations

• Two-challenge rule

• CUS words

• DESC script

Explain the two-challenge rule

Voice a concern at least twice to ensure it has been acknowledged

Explain CUS words

Use phrases to signal immediate attention is required:

• I am concerned

• I am uncomfortable

• This is a safety issue

Explain DESC script

Steps to take when managing conflict:

• Describe the situation

• Express concerns

• Suggest alternative

• State Consequences