ATSP

Introduction

ATSP: asked to see patient

ATSP is a common indication for the nurses to call the doctors, particularly whilst covering the out of hours. 

ATSP usually refers to a symptom (present or worsening) or observation derangement, which mandates a medical review. 

Common ATSP 

Symptoms

• Non specific

  • General decline/ unwell

  • Fall, dizziness

• Pain- chest, abdominal, headache, limb

• Chest

  • Cough, haemoptysis, shortness of breath, 

• GI

  • Nausea or vomiting

  • Constipation

  • Diarrhoea

  • Haematemesis or haemochezia

• Urinary

  • Retention

  • Dysuria

  • Haematuria

• Rash

Observations

Heart rate

• Tachycardia

• Bradycardia

Blood pressure

• Hypertension

• Hypotension

Respiratory rate

• Tachypnoea

• Bradypnoea

Oxygen Saturations

• Hypoxia

Temperature

• Hyperthermia: Pyrexia

• Hypothermia

Investigations

• FBC- Hb or platelet drop

• Raised inflammatory markers- CRP, neutrophils

• Electrolyte derangement

  • Na+: HypoNatraemia  & HyperNatraemia

  • K+: HypoKalaemia & HyperKalaemia

  • Ca2+: HypoCalcaemia & HyperCalcaemia

  • Mg2+: HypoMagnasaemia 

  • PO4/3-: HypoPhosphataemia

• Cardiac- ECG, telemetry, ECHO, BNP, troponin, d-dimer

• Chest XR- NG tube, pneumonia, pneumothorax

General Points

Priority

• Triaging jobs out of hours is difficult, generally ATSP concerns should be a high priority

• This is because the patient may be unwell

• Often individuals asking for a review are correct in their assessment that this patient requires medical input but can be poor at articulating the problem, hence the importance of early reviews

Hospital Setting

• Inpatients are in a well supported hospital setting and can be monitored to allow for the condition to fully present itself

• Furthermore, watch and wait approach can be reasonable to see if the patient clears it themselves

• On the other hand, these patients can be frail and early interventions achieve better outcomes

Indications to call peri-arrest pagers

• Commonly, I've been called about conditions that require the peri-arrest pager, it is useful to know these:

  • Conditions

    • Seizure

    • "Tensioning" pneumothorax: unwell

    • Severe sepsis

    • Life threatening asthma exacerbation

  • Severe observation derangement

    • Saturations < 92% on 15L high flow

    • BP << 90/60 

    • HR >> 160

    • GCS < 8

  • Severe symptom burden, i.e. severe pain- chest, abdo, limb

Escalating

• I struggled with the question of when to escalate until I started receiving escalation questions myself

• Only indication to escalate is that your concerned, have to follow gut feeling and shouldn't second guess or over critique yourself

• Under-escalating affects patient care but over-escalating is irritating, of the two it is better to be irritating than unsafe

• It is normal for the inexperienced to require a low threshold for support

Resources and References

Written in 2025