ISOBAR: Case 00001

The ISOBAR (identify–situation–observations–background–agreed plan–read back) technique is a way of organising your thoughts for a hand over of a sick or worrying patient. Because you want to leave and your colleague wants to get to work, it must be succinct, accurate and informative (pithy?). You will in all probability have to learn how to craft one of these, it won't come naturally.

Hello, I am the ICU registrar going off duty. I have a previously healthy 45 y.o man who is now day 4 postop. On day 3 after an uncomplicated APR for rectal cancer, he developed respiratory problems with tachycardic, tachypnoeic, desaturating on room air, hypoxic with a borderline acidosis and hypercapnia with signs at the R lung base and bibasal atelectasis on CXR. He was mildly febrile, and his cardiovascular system was stable. Today his hypoxia worsened despite supplemented O2 and he has been intubated and transferred to ICU with a provisional diagnosis of pneumonia. I have not seen his ECG but I expect no abnormalities on his ECG, nor his CT Chest but there has been no suggestion of metastases to date.

Or the shorter version,

Hello, I'm going home. Bed 1 is a previously healthy 45 y.o man, now day 4 after an uncomplicated APR for rectal cancer, yesterday he had developed breathing problems and atelectasis was found, his hypoxia deteriorated today and he has just been intubated. He may have a pneumonia, but they haven't excluded PE. Nothing so far suggests heart or cancer problems. You need to look at his ECG and CT Chest. No cultures have been done.

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