The critically ill: following your MEWS

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Abstract
A 62‐year‐old man with a chest infection is admitted to hospital as an emergency. For the following 5 days, he remains on a ward with a tachycardia of 120–130 bpm and respiratory rates in the mid 30s to low 40s. Despite supplemental oxygen, his recorded saturation often dips below 90%. Five days after admission, he becomes confused and then drowsy. At this time his systolic blood pressure falls below 80 mmHg. His urinary output is not recorded, although his creatinine increases over 6 days from 212 mmol/l at admission to 369 mmol/l. Doctors are concerned and make frequent visits, analyse several arterial blood gas samples and institute intermittent mask continuous positive airway pressure (CPAP) support. Six days after admission a registrar, not involved in the patient's care, notices from the end of the bed that the patient is moribund. The patient is admitted to the intensive care unit (ICU) and is intubated, ventilated and haemofiltered. The patient dies on the ICU 24 days later.

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