Table of Contents
Overview #
- A MET Call (Medical Emergency Team) is a hospital system designed to identify, review and treat acutely unwell patients.
- Attend MET calls for your patients immediately
- The aim of this guide is for junior doctors to initialise assessment and stabilise patients until the MET team arrives.
MET call criteria (may differ between health services)
- RR< 6 or > 36
- SpO2 < 90%
- SBP< 90 or > 200
- HR < 40 or > 140
- Unexpected decrease in conscious state
- Other: concern for any reason, pain crisis, prolonged seizure, massive bleed
Where there is an immediate threat to someone’s life, a Code Blue response should be activated instead of a MET call. These situations include:
- Cardiac arrest
- Threatened airway
- Ventricular tachycardia
- GCS <8 / unresponsive
Initial Assessment #
Summarised Steps
- Step 1: Establish trigger for MET call
- Step 2: Address ABCD whilst receiving Handover
- Step 3: Review medical records, medication chart and recent investigation
- Step 4: Arrange Investigations (Marked as Urgent) as required
- Step 5: Arrange to follow up
- Who will chase Ix?
- need for increased frequency of obs
- Planned review
- Altered criteria
- Notify family
- Notify Treating team
- documentation
Key handover information to receive from bedside nurse
- Reason for MET call
- Patient name, age and sex
- Vital signs
- Reason for admission and significant past medical history
- Goals of care
- Events leading to MET call
Parallel primary survey and resuscitation
| Primary survey | Resuscitation | |
| A | Check patency | As required:
|
| B | RR, SpO2Work of breathingAuscultate lungsRespiratory symptoms? | If SpO2 below target for patient apply supplemental oxygen, refer to hypoxia guideline) |
| C | HR, BPWarm/cold peripheriesAuscultate heartECGCardiac symptoms? | Obtain two 18G IV access and draw bloodsIf hypotensiveTilt head of bed down250-1000mL of normal saline IV bolus Reassess haemodynamics |
| D | BSL AVPU or GCS Pupil size and reactivity Spontaneous movement of all limbs Facial droop Seizure activity |
|
| E | TemperatureExamine abdomenExamine lower limbs for DVTInspect for wounds/bleedingInspect skin for rashPain? | Symptomatic managementAnalgesiaAntiemetics |
Investigation #
Mark investigations as URGENT
| Common MET investigations |
| BSLECGVBGLactateFBE, UEC, CMP, LFT, CRPCoagulation studiesMobile CXRTroponin |
| Further investigations | Rationale |
| ABG | Hypoxia, hypercapnia, acid-base disturbance |
| Group and hold +/- crossmatch | Suspect bleeding |
| Serial troponin | Suspect cardiac injury |
| Septic screen (blood cultures x2, urine MCS) | Suspect sepsis |
| TFT | Tachycardia |
| D-dimer +/- *CT pulmonary angiogram OR *V/Q scan | Suspect PE |
| *CT abdomen and pelvis | Suspect acute surgical abdomen |
| *CT angiogram | Suspect dissection or bleed |
| *CT brain (noncontrast) +/- perfusion and circle of Willis angiogram | Suspect intracerebral bleed or stroke |
Further Assessment #
Gather more information
- Review medical record
- Review medication chart
- Review recent pathology and imaging
- SPEAK UP if you know something about the patient
- Continue to gather more information including external information and collateral
Do not leave unless dismissed or MET call is stood down
Handover to MET Team #
- Identify yourself
- Reason for MET call
- Patient name, age, sex, admitting unit
- Vitals
- Reason for admission and significant past medical history
- Goals of care
- Events leading to MET call
- Salient findings on assessment
- What have you done and what you are about to do
Final Checklist #
- Order investigations
- Update home team
- Make referrals as required
- Attend to family
- Documentation
Contributors
Reviewing Consultant/Senior Registrar
Dr Kwan Yun Lee
Dr Scott Santinon
