ISBAR

Introduction
Nurse Jet: Good Morning, Dr. Tolentino! This is Nurse Jet from the Emergency Room. I am assigned to Mr.
Carson, ETA in the ER is at 11:05AM. I am calling to refer a patient to your department (infectious disease).

Situation
Nurse Jet: Our patient is a 61 y/o Male wheeled to ER by EMS after reports of having a witnessed syncopal
episode in the parking lot of a grocery store this AM without reported injury. CC: Fever, cough and Syncope.

Background
Nurse Jet: Patient is alert and oriented, he told me that the same symptoms he was experiencing now were
experienced by family members at home, onset is only today. Currently, he is complaining of SOB and nausea.

Assessment
Nurse Jet: Currently, O2 Saturation is sitting at 89%, Hyperthermic at 40 degrees Celsius, positive chills.
Tachycardic with PR of 107 on regular rhythm. Patient’s BP and RR are normal otherwise. Not currently in
respiratory distress but was observed to have prolonged expiratory phase. Ronchrous breath sounds are present
bilaterally on the base of the lungs, there is mild oropharyngeal erythema noted upon assessment. Patient
reports of having nonproductive cough, and he also complains of Nausea, however no vomiting episode
reported. Additional findings include loss of taste and smell for 2 days now and diffuse body aches.

Recommendations
Nurse Jet: Based on my assessment findings, the client’s symptoms are congruent with COVID-19 diagnosis. I
have activated isolation protocol in the ER per hospital policy, advised my team to use PPE at all times and
advised a colleague to reach out to family members for us to see if there are recently confirmed diagnosis of
COVID patients at home for us to corroborate our differential diagnosis and to activate contact tracing
procedure. Per your approval and given the presented signs and symptoms, I would assume you would like to
admit this patient? If so, I can advise our admissions team to check if an isolation bed is available, just in case. Is
that ok with you?

Dr. Tolentino: Yes, that is the right call. Initiate strict isolation protocol until COVID-19 diagnosis is confirmed.

Nurse Jet: Thank you Doc! Tissue Perfusion and oxygenation is my priority concern, O2 Sat is currently at 89%.
The patient admits that he is a current smoker with a past MHx of COPD. Can I get an order for O2 via NC? How
many liters? Since you concurred with me on the admission recommendation, I will insert an IV line. Do you have
some fluid recommendations? NS 1L?

I would imagine you have some laboratory tests you would like to order? COVID RT-PCR to confirm Dx? CBC,
Basic Chem, Blood Culture, Liver Function Test, Lactate Level?
For Radiology, can we also get an order for CXR? With that syncopal episode earlier and slight increase in HR, can
I also request for a 12 Lead ECG just to be sure?

Dr. Tolentino: I agree with all your recommendations, I will write the orders now. Continue to monitor the O2 sat
and update me if the supplemental oxygen helped. Advise Lab to prioritize RT-PCR test please.

Nurse Jet: Absolutely Doc! I will carry out all those recommendations right away! We will also perform Tepid
Sponge bath in an effort to decrease the body temperature, while you’re working on those orders, can we also
request for antipyretics? Btw, our patient has no known medication or drug allergies.

Dr. Tolentino: You can administer Acetaminophen 500mg PO STAT, then q 4. Once diagnosis is confirmed, I will
immediately write an order for antibiotic therapy so we can start the patient on an antiviral medication
(Remdesivir).

Nurse jet: Sounds like a plan Doc! How about the Nausea? Can we also administer anti-emetics like Zofran or
Metoclopramide?

Dr. Tolentino: Sure! I will add that in my order and come to the ER for further evaluation.

Nurse Jet: Thank you Doc! Will keep you posted on any development in Mr. Carson’s case. Hopefully, the next
time I call is when he’s stable and ready for hand-off, waiting for your admission orders. See you around!