The escalation card: fifteen triggers and a ten-minute drill
The fifteen triggers set as a single index card in a rust keyline, taped at two opposing corners, with a folded lower right corner carrying the book number.
THE ESCALATION CARD
| Trigger | First action | |
|---|---|---|
| ☐ | Hematemesis or coffee-ground emesis | Access, fluids, notify |
| ☐ | Melena with a rising blood urea nitrogen | Treat as upper bleed |
| ☐ | Rigid abdomen with absent bowel sounds | Nothing by mouth, page surgeon |
| ☐ | Sudden relief of appendicitis pain | Suspect rupture, notify |
| ☐ | Constant obstruction pain with fever | Suspect strangulation, notify |
| ☐ | Chvostek or Trousseau sign in pancreatitis | Seizure precautions, notify |
| ☐ | Distension with fever in a colitis flare | Hold antidiarrheal, notify |
| ☐ | A dusky or black stoma | Report immediately |
| ☐ | Asterixis or new sleep-wake reversal in cirrhosis | Safety, notify, lactulose |
| ☐ | Any hematemesis in a cirrhotic | Treat as bleeding varix |
| ☐ | Fever, chest pain, falling saturation in sickle cell disease | Oxygen, escalate now |
| ☐ | Any new symptom in the first fifteen minutes of a transfusion | Stop the transfusion |
| ☐ | A single fever in a neutropenic patient | Cultures, then antibiotics |
| ☐ | New back pain or leg weakness in cancer | Urgent imaging, notify |
| ☐ | Burning or lost blood return during a vesicant infusion | Stop, aspirate, notify |
The ten-minute drill
Cover the first action column with your hand. Work down the fifteen triggers and say the first action out loud before you look. Tick only the ones you answered without hesitating, and never tick one you talked yourself into. Then reread the page in this book that owns each miss, and run the whole card again the next day. Two clean runs is the standard, not one.
☐ Drill run clean twice.
Margin notethe whole book is one sentence: say it out loud, then act.
The transfusion trigger and its first action are verified against current AABB standards, and the surrounding procedure follows institutional policy.
Takeawayfifteen findings in this domain end deliberation, and knowing them cold is worth more than knowing every disease on these pages.
Every value → BOOK 07. Precaution mechanics → BOOK 04. Drug class logic → BOOK 05. Calculations → BOOK 06. Shock → BOOK 09. Delegation → BOOK 03. The final countdown → BOOK 16.