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Pews Charts 4 11 Months
Pews Charts 4 11 Months
Pews Charts 4 11 Months
ISBAR
• Gasping, grunting
Identify Situation Background Assessment Recommendation
Other
• Extreme pallor, cyanosis
Communication Tool • Apnoea
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Paediatric Sepsis 6
Version N3 | 2016
PEWS Score Key
4-11 Months Chart Date D D / M M / Y Y
0 1 2 3
Date / Time Clinical Parameters New Acceptable Range Next Medical Review Doctor
Signature/Print name /MCRN
Addressograph
Ward
Parameter
Amendment
For Chronic Conditions
Consultant
Core Year Date 12/12 Core
Parameters Parameters
Time 18:45
Frequency of observations 40
RR Number 38
RR Score 0 RR Score
Severe Severe
Respiratory Moderate Moderate
Effort Mild Mild
Normal Normal
RE Score 0 RE Score
Mode of O2 delivery Mode RA Mode
Room air (RA) Oxygen
Nasal Cannula (NC)
Pressure Pressure
Face mask (FM) Therapy
/0LQV
>2L >2L
Tracheostomy (T)
HHFNC (H) / /
CPAP (C) / BiPAP (B) O2 T Score 0 O2 T Score
98
SpO2
SpO2 Score 0 SpO2 Score
180 180
170 170
C 160 160
CIRCULATION 150 150
Heart Rate 140 140
If HR scores 1 or more
consider central CRT (beats per minute) 130 130
and BP and refer to Assess for 120 120
Sepsis 6 Protocol 60 seconds
110 110
100 100
90 90
80 80
*HR <60 with no signs of 70 70
life - begin CPR and
60 60
call the emergency team
HR Number 119
HR Score 0 HR Score
Central Capillary >2 >2
Refill Time (seconds)
CRT Score 0 CRT Score
130 130
Blood Pressure 120 120
(mmHg) 110 110
Score systolic BP 100 100
90 90
Cuff Size:
80 80
________ 70 70
60 60
BP Number 89
BP Score 0 BP Score
PK - pink M - mottled
P - pale C - cyanosed Skin Colour PK Colour
6FRUH¶·LIQRWDVVHVVHG Alert A
and put a vertical line Voice V
through column
AVPU P
D Pain
DISABILITY Unresponsive U
If not Alert, consider GCS AVPU Score 0 AVPU Score
E Temperature
ʝ
EXPOSURE
Record
Consider sepsis if
temperature <360&RU!0C as graph
Notify doctor if urine output
is <1mL/Kg/hr