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NEWS2 Escalation — FRCA Final MCQ

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ModeratePerioperative MedicineNEWS2 EscalationFRCA Final

A 78-year-old man (ASA III) undergoes emergency hip hemiarthroplasty under spinal anaesthesia. In recovery, his aggregate NEWS2 score rises from 3 to 7 over 2 hours. No individualised escalation threshold has been agreed. According to the RCP NEWS2 escalation framework, what response is required?

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Reveal the answer and explanation

Correct answer: C — Arrange emergency assessment by a team with critical-care competencies, including advanced airway-management skills

Explanation lettering: B = shown as A · E = shown as B · A = shown as E

An aggregate NEWS2 score of 7 or more is the RCP high-risk, emergency-response threshold. It mandates continuous monitoring of vital signs, immediate notification of the responsible medical team, and emergency assessment by a team with critical-care competencies, including advanced airway-management skills, with consideration of transfer to a level 2 or 3 care area. Option C is therefore correct. Option B describes the urgent response reserved for an aggregate score of 5–6 (or a red score of 3 in a single parameter); it is insufficient once the aggregate reaches 7. Four-hourly observations (A) suit low scores (1–4); routine observations (D) suit a score of 0. Informing the nurse in charge and rechecking in an hour (E) would dangerously delay definitive escalation. Note that a score of 3 in one parameter triggers urgent review, not the emergency response.

Reference: NICE. Medtech innovation briefing MIB205: National Early Warning Score systems that alert to deteriorating adult patients in hospital – The technology (NEWS2 trigger thresholds: high risk, aggregate score ≥7, emergency assessment by critical care team). 2020. https://www.nice.org.uk/advice/mib205/chapter/The-technology