4. Abnormal findings — the necessity chain
Finding → severity → comparison → risk → intervention → notification (provider + representative) → orders → response → reassessment.
Model abnormal 1 |
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Significant epistaxis on anticoagulation: an active, brisk nosebleed not controlled with initial pressure, in a resident on warfarin — a bleeding concern with a hemodynamic risk. Continuous firm pressure applied and the resident positioned to protect the airway, vital signs monitored, the anticoagulation status reviewed and the next dose addressed per parameters, SBAR to the provider, orders received (evaluation, possible packing/cautery, labs), and the responsible party notified. Will reassess bleeding and vitals; supports the Section I update. Skilled management and bleeding surveillance required. (Anticoagulation management routes to the Anticoagulation overlay.) |
Model abnormal 2 |
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CSF-rhinorrhea concern after neurosurgery: new clear, watery drainage from one nostril in a resident recovering from a craniotomy/transsphenoidal procedure — concerning for a cerebrospinal-fluid leak. The neurosurgery service and provider notified urgently, the resident kept with the head-of-bed per order and instructed not to blow the nose, the drainage characterized, and neuro status monitored. Will reassess; supports the Section I update. Skilled recognition required, as a CSF leak risks meningitis. (The neuro/head course routes to the Head/Scalp and Neurological references.) |