A recovery nurse calls you to a patient who is not right. This is the archetypal clinical judgement scenario because it gives you very little information and asks what you do — which is exactly what the station is for.
How do you approach it?
Go and see the patient, and say so. A candidate who starts by asking for observations over the phone has already lost the station. Assess A–E while asking the recovery nurse what has changed and when.
- Airway — obstruction from the tongue, laryngospasm, or a patient too sleepy to protect it
- Breathing — hypoventilation from residual opioid or incomplete reversal of neuromuscular blockade
- Circulation — bleeding, hypovolaemia from a long fasted period, or the vasodilatation of a regional block
- Disability — sedation score, pupils, and glucose
- Exposure — the wound, the drains, and the patient's temperature
What are the causes worth naming?
Recovery deterioration has a short and predictable differential, and knowing it lets you look purposeful rather than generic.
- Airway obstruction and laryngospasm — the most immediately dangerous
- Residual neuromuscular blockade, which is why quantitative monitoring matters
- Opioid-induced respiratory depression
- Surgical bleeding — the deterioration that will not respond to anything you do in recovery
- Pain, which drives tachycardia and hypertension and is easy to under-treat
When and how do you escalate?
Early, and concretely. Say who you would call — your consultant, the surgical team if you suspect bleeding, critical care outreach — and what you would ask them for. If the answer is that the patient needs to go back to theatre, say that: recognising a problem you cannot fix in recovery is the judgement being marked.
Expect the scenario to turn. You are asked to be in two places at once, or the surgeon wants to start the next case. Prioritising the unstable patient and saying plainly why is the answer; the panel is watching whether you can hold a position under mild pressure.