“Doctor…the patient is MEWSing”

This, ladies and gents, is one of the most common things I have heard this week. It is, actually the most common things I hear every week. So it begs the question…what does it all mean?

A “MEWSing” patient is essentially a potentially unwell patient. It serves as an indicator for all health care professionals that come into contact with that patient as to the status of their health. This is both for that very moment in time, and compared with the MEWS of the patient over the last few days.

So what a MEWS consist of?

MEWS: MEDICAL EARLY WARNING SCORE

  1. Respiratory Rate
  2. Body Temperature
  3. Blood Pressure
  4. Heart Rate
  5. Oxygen Saturation (and if supplemental oxygen is being given)
  6. Urine output (we want better than or equal to 30 millilitres of urine passed an hour)

When a MEWS score goes above 3 (it varies between hospitals) the nurses alert us, the doctors, to come and assess the patient for something is essentially not quite right with the patient. It may be that the patient has an early infection brewing – such as a chest infection, a post-operative complication and they are bleeding internally, or perhaps a reaction to a new medication or blood transfusion. Bottom line is the MEWS allows us to intervene early so that nothing else really nasty can take hold – such a sepsis – a widespread blood infection that can affect all organs and kill.

So, let me give you an example of this MEWS in action. I get a bleep on Tuesday and the nurse quite rightly says “you have a MEWSing patient on X ward – can you please review them?” So off I go and see them, putting down my skinny latte and golf clubs. The patient has a temperature (a pyrexia) and a fast heart rate (a tachycardia) and is recently out of surgey. They have a MEWS score of 5. In a situation like this your big concerns are a post-operative complication (bleeding, infection and so on) and – yes – potential sepsis! Doctors ALWAYS think sepsis for most situations. Why? Quite simply you do it because if you were to miss it and don’t treat quickly the chances of the patient surviving (if it was indeed sepsis) is rubbish. So with a MEWS of 5, and the devil on your shoulder whispering “sepsis!!”, you go a little onto autopilot and do the following: (1) clinically assess the patient i.e. listen to the chest and lungs, (2) perform a septic screen including taking blood from a vein in the arm, performing an arterial blood test from the pulsating artery in the wrist (to see if the body is acidotic), ordering a chest radiograph (to see if there is a chest infection), and testing the urine i.e. a ‘urine dip’. Basically what we are doing is looking for a source of infection.

Then, while all this is going on we try to ‘optimise’ our patient by making sure the body is coping alright. We essentially take the load of the body and so give intravenous fluids to maintain blood pressure and keep heart rate stable; start antibiotics to pre-empt an infection, pop a urinary catheter in (as we want to monitor both the fluid input and output and make sure they balance i.e. the patient is ‘euvolaemic’)…and then we wait for the results.

Often then we find out that the patient has a urine infection or chest infection (like hospital acquired pneumonia) and luckily the antibiotics we have started them on is enough to have them ship-shape in no time at all! However, when it goes bad…it goes very bad…

You see the scary times are when a patient has ‘septic shock’! This is essentially when the patient is so overcome with infection that their body’s blood vessels dilate (widen) so much that the blood pressure plummets and the heart rate shoots up! That is when the patient is very very sick. Organs get damaged as a result and the body goes down a slippery slope towards death. If I have even a sniff that this is happening, that is when it’s time to get the seniors involved – and often the patients are carted off to intensive care…

Right, as I am on day 14 of a 19 day straight run of shifts and having done a 10 hour shift and cycled 9 miles to and from work, I have worked up an appetite so I am going to leave it here for this week and say goodnight!

See you next week guys,

Dr Nick

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