NU2ICU V3 logoASSESSMENT – RRS / MET VALUES

So whats considered dangerous? When to be worried and when to call for assistance

RRS stands for Rapid Response System,  MET for Medical Emergency Team or sometimes it is even called MER for Medical Emergency Response, whatever you call them in your hospital they are a team of highly trained specifically roled clinicians that will attend to your patient in alignment with set criteria or even just ‘cos you’re worried.  Nearly every hospital today has a team from either ICU, ED or Cardiac areas that performs as this assistance team

Here are examples of the set criteria

ACUTE CHANGES IN PHYSIOLOGY
Airway
Anything that would threaten the safety or patency of the airway and patients ability to breathe
 

Breathing

Respiratory Rate Value Rationale
< 6 Danger of hypoxia and hypercapnoea – does not support enough gas exchange to maintain life in the long term, need to exclude cardiac arrest, stroke, over medication etc
> 30 Danger of hypoxia and hypocapnoea – signifies possible impending respiratory failure need to exclude reversible causes ie pain, fluid overload, infection etc
Rapidly changing Danger of hypoxia, rapid changes signify evolving disease states that require immediate therapy
SaO2 < 90% If new problem may signify respiratory or cardiac complications, give oxygen in interim to SaO2 > 92%
 

Circulation

Range Value Rationale
Pulse < 40 Danger of loss of cardiac output, new bradycardia may signify evolving cardiac events, over medication etc
> 130 Danger of loss of cardiac output, new tachycardia may signify evolving cardiac events, under medication, increased risk of thrombotic events, many other body systems can trigger life threatening tachycardia etc
Systolic BP < 90 Danger of under perfusion of the entire body if sudden / new, may signify shock / sepsis, hypovolaemia, cardiac event, over medication etc

 

 

Neurology

Range Value Rationale
Consciousness Unexplained fall in level Danger as sudden drop may indicate stroke or intracerebral bleed, cardiac event, profound hypotension, over medication etc
GCS fall > 2 points As above
Repeated or Prolonged Seizures Danger as ongoing unrelieved seizure activity may indicate intracerebral bleed, under / over medication, long period of seizures can cause hypoxia leading to global ischaemic problems
 

Renal

Range Value Rationale
Reduced urine output < 30mls over 2 consecutive hours Danger as urine output is required for maintenance of homeostasis, ongoing low output may indicate hypovolaemia of many causes, bleeding, obstruction, sepsis / shock etc
 

Other

Range Value Rationale
Any patient about whom you are seriously worried Your ability to assess Danger of ignoring the “gut feeling” that makes you concerned about your patients safety, risk of your concerns becoming reality without intervention, may signify anything from impending cardiac event to continuous unrelieved inappropriately treated pain etc

REFERENCES

Suggested RRS calling parameters International Society for Rapid Response Systems (iSRRS) 2013

 

More reading

GENERAL ASSESSMENT

PRIMARY ASSESSMENT

SECONDARY ASSESSMENT

KNOWLEDGE ADJUNCTS

AUSCULTATION SKILLS

NORMAL VALUES

ASSESSMENT PRACTICE TOOL