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The catastrophic deterioration of a patient is usually preceded by a series of physiological signs. These signs have been categorized as early or late and have been used to formulate early-warning systems. Early-warning scoring systems are key tools for outreach services, allowing them to identify patients at risk of developing severe adverse events, such as death, cardiac arrest and emergency admission to the Intensive Care Unit. Assessment of the critically ill patient should follow the ABCDE (airway, breathing, circulation, disability and environment) format. This allows a systematic approach in examining the patient for signs of critical illness and with the incorporation of a scoring system can help to guide further management. Scores derived from early-warning systems can be used both as indicators of illness severity and as a trigger for intensive care admission once a specific threshold value is reached. There is ongoing debate in the literature with respect to the impact of outreach services on patient outcome. Nevertheless, the ability to recognize early signs of critical illness remains a core skill for all trainee doctors. |
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