PRF Assistant

SOCRATES Prompts

• SWhere exactly in the head is the pain?
• OWhen did it start? What were you doing when it started?
• CCan you describe the pain?
• RDoes the pain move anywhere?
• ADizziness? Vision or speech problems?
• ANumbness / altered sensation in face or limbs?
• AFacial droop? Unilateral limb weakness?
• ANew-onset confusion? LOC? Seizure activity?
• APhotophobia? Neck stiffness? Non-blanching rash?
• AHistory of head trauma? On anticoagulants?
• TConstant or intermittent?
• EAnything make it better or worse?
• SPain score out of 10?

PRF Builder

Seizure History Prompts

• Can a witness describe the seizure?
• Did the patient go completely unresponsive?
• Any muscle twitching, limb jerking or stiffness?
• Any abnormal eye movement? Incontinence? Oral trauma?
• Duration of seizure activity?
• More than one seizure? Any treatment given (e.g. buccal midazolam)?
• Known to have seizures? How often? How do they usually present?
• Care plan in place for seizures?
• History of diabetes? Recent illness/infection?
• Diagnosed brain tumour? Recent head injury?
• CVA symptoms reported prior to seizure?
• Alcohol dependant? Could they be withdrawing?
• Any mental health history? Possible overdose?
• Post-ictal period — duration? Current GCS?

SOCATE Prompts

• When did they fall? Time and place?
• Can they remember falling?
• Intrinsic cause (illness/dizziness/syncope) or extrinsic (trip/slip)?
• Fall from standing? Seated? At height? Furniture/mobility aid involved?
• What surface did they land on? How did they land?
• Any LOC? If so how long?
• Any new pain or injury from the fall?
• Headache? Dizziness? FAST symptoms? Seizure activity?
• SOB? Chest pain? Palpitations?
• Abdo pain? Back pain? Urinary symptoms?
• How long have they been on the floor?
• Any previous falls? Frequency?

V — Vasovagal

Hot environment? Prolonged standing? Dehydrated? Quick recovery post-syncope?

O — Orthostatic Hypotension

Perform lying → seated → standing BPs. Postural drop ≥20mmHg systolic.

SOCATE Prompts

• When did breathing problems start?
• What were you doing when it started? Gradual or sudden onset?
• Has this happened before?
• Can you describe how your breathing feels?
• Cough? Productive or dry? Sputum colour? Haemoptysis?
• Chest pain?
• Abdominal pain?
• Lower limb swelling/fluid retention? (oedema)
• Lower limb pain/tenderness? (DVT)
• Recent long-haul flight? Surgery? Immobility? Chemotherapy?
• Known allergies? Any hives?
• How long have symptoms been present?
• Anything improve or worsen breathing?

Wells Criteria

SOCRATES Prompts

• SWhere exactly in the chest?
• OWhen did it start? What were you doing?
• CDescribe the type of pain — crushing/sharp/burning/ache?
• RDoes it move — arms/jaw/neck/back?
• AShortness of breath?
• APale/clammy/sweaty skin?
• APalpitations? Dizziness?
• ANausea or vomiting?
• ACough? Productive? Sputum? Haemoptysis?
• ALower limb/lower back swelling? (oedema)
• ACalf/lower limb pain or swelling? (DVT)
• AAbdominal pain?
• ARecent long-haul flight? Surgery? Immobility? Chemotherapy? OCP?
• TConstant or intermittent?
• EAnything make it better or worse?
• SPain score out of 10?

SOCRATES Prompts

• SWhere exactly in the abdomen?
• OWhen did it start? What were you doing?
• CDescribe the type of pain — sharp/burning/cramping/constant?
• RDoes it move anywhere?
• ANausea or vomiting? Bile? Food? Haematemesis?
• ABowel movements — normal/loose/diarrhoea/melaena/constipation?
• AUrinary symptoms — frequency/volume/pain/haematuria/urgency/colour/odour?
• ALower back pain or discomfort?
• ASOB? NSAID use? (ulcers/GI bleed)
• ASyncope? LOC? Dizziness or lightheadedness?
• A ♀PV bleed/discharge? Chance of pregnancy? LMP (date and normal)? Contraception? Pelvic pain? Shoulder tip pain?
• TConstant or intermittent?
• EAnything better or worse?
• SPain score out of 10?

Abdominal Regions

SOCRATES Prompts

• SWhere exactly in the back?
• OWhen did it start? What were you doing?
• CDescribe the type of pain.
• RDoes it move anywhere?
• A 🔴Any pain/numbness/altered sensation in lower limbs?
• A 🔴Any bowel or urinary incontinence?
• A 🔴Any saddle anaesthesia? (numbness in buttocks/perineum/inner thighs)
• AHistory of trauma?
• AAbdominal pain?
• ADizziness? SOB? Syncope? Pale/clammy/sweaty?
• AUrinary symptoms — frequency, volume, pain, haematuria, urgency?
• TConstant or intermittent?
• EAnything make it better or worse?
• SPain score out of 10?

Diabetic History Prompts

• How long have they had diabetes?
• Are they insulin-dependent?
• When was their last insulin injection?
• Have they made any changes to their diet?
• When was their last carbohydrate-containing meal?
• Have they been more active than usual?
• Excessive thirst (polydipsia)?
• Excessive hunger (polyphagia)?
• Excessive urine output / increased urge (polyuria)?
• Is their diabetes well managed? Previous hypo or hyper episodes?
• Previous hospital admission relating to diabetes?
• Any recent infections?
• When was their last diabetic review with GP/nurse?

TECP Prompts

• THow many weeks pregnant?
• EExpected delivery date / LMP?
• CResults of last scan? Last time foetus was felt?
• CBaby's position? Any health concerns?
• CEclampsia? Pre-eclampsia? Gestational diabetes?
• PHow many previous births (parity)?
• PPrevious pregnancies (gravida)? Quick births? Abnormal deliveries?
• PHistory of miscarriage or ectopic pregnancy?

Progression Prompts

• Contractions — time started, duration, how far apart?
• Show — time occurred, consistency?
• Waters — time broken, consistency (clear fluid?)?

Paediatric Assessment Blend

• AAirway — secretions? foreign body? croup? drooling? inflamed tonsils?
• BBreathing — RR? recession? accessory muscles? equal chest rise? stridor? wheeze? crackles? nasal flaring?
• CCirculation — pulse rate? cap refill? SpO₂? colour? peripheral temperature? mottled skin?
• DDisability — crying appropriately? muscle tone? PEARL? AVPU? photophobia? neck stiffness? non-blanching rash? Brudzinski's/Kernig's sign?
• EAbdomen soft and non-tender? Nausea/vomiting? Feeding history? Wet nappies? Bowel movements normal? Temperature? BM?

General Prompts

• How can we help you today? What's happened?
• Recent events that may have affected how they're feeling?
• What support is in place? (family/friends/MH teams/GP)
• Diagnosed with any mental health conditions?
• Do they take medication? If so, have they been compliant?
• Have they taken any medication in excess or self-harmed today?
• Do they have any thoughts of suicide?

Bleeding History Prompts

• When did it start?
• Spontaneous onset or trauma related?
• Estimated blood loss?
• Still actively bleeding?
• Blood consistency — any clots? Bright or dark?
• Antiplatelet or anticoagulant medication?
• Has this happened before?
• Abdominal pain? Back pain? (PV/PR)
• Bowel movements normal? (PR)
• Urinary symptoms? (PR/PV)
• Nausea/vomiting blood? (PR)
• Bleeding from both nostrils or just one? (epistaxis)

ATMIST Prompts

• AAge of patient?
• TTime of incident?
• MMechanism — height if fallen, speed of vehicles, damage to vehicles/helmets, airbags deployed?
• MBlunt, penetrating, or crush injury? Time crushed?
• IInjuries sustained — LOC? Location of pain?
• SSigns — current obs, GCS, SpO₂?
• TTreatment — interventions already performed?

D — Disability

GCS, pupils, assess for head injury, FAST.

DRSID — Arrest Record

• DDowntime — how long in cardiac arrest?
• RRhythm — initial arrest rhythm + subsequent rhythm changes?
• RROSC — time of return of spontaneous circulation (if achieved)?
• SShocks — total number delivered?
• IIntubation / iGel — time of advanced airway insertion?
• IIV / IO — time of vascular access?
• DDrugs given — record all with times?

Drowning

Consider hypoxia, hypovolaemia, hypothermia. Maintain horizontal positioning in water where possible. 5 initial ventilations take priority. Consider head and neck injury.

SBAR Medical Handover