SJT: Free Q: 1P: Competing bleeps on the medical take

FREE MSRA PODCAST QUESTION— SJT (Priority) 🎧
High-yield breakdown of a classic “competing bleeps” scenario: triage under pressure, early escalation, and safe delegation. 🧠⚡️

Clinical vignette
You’re the medical SHO covering two wards on an early evening shift when several demands arrive at once: (a) a 72-year-old with pneumonia is acutely dyspnoeic with SpO₂ 82% on air; (b) ED wants TTAs for a stable discharge “in 30 minutes”; (c) Radiology phones with a routine outpatient US query; (d) an FY1 asks you to check warfarin dosing before 18:00; (e) a relative requests an update via switchboard. The nurse in charge can assist; the medical registrar is busy but contactable; ALS/2222 is available.

Question
Select the THREE most appropriate actions to take now.

Options

1. Go immediately to assess the hypoxic patient with ABCDE, give oxygen per protocol, request observations and a VBG.

2. Call 2222/ALS or the medical registrar for urgent support while en route, giving a concise SBAR.

3. Ask the nurse in charge to pause/redirect non-urgent bleeps; inform ED TTAs will be delayed; document reprioritisation.

4. Prioritise writing the ED TTAs first because patient flow targets must be met.

5. Tell the FY1 to hold warfarin and you’ll review later, without assessing the patient.

6. End the radiology call by telling them to ask the GP instead, as it’s not urgent.

7. Ask the ward clerk to take the relative’s details and arrange a call-back later; ensure consent/ID checks before any update.

8. Advise the nurse to escalate to outreach/critical care only if the patient arrests.

ANSWERS AT THE END (scroll to end)

Brief explanation

• Immediate safety first: Severe hypoxia (SpO₂ 82%) demands ABCDE, oxygen, monitoring and early gas (NEWS2/NICE/GMC).

• Early escalation: Alert 2222/ALS or the registrar on the move; use SBAR to save time and share risk.

• Prioritisation & delegation: Insulate non-urgent tasks (TTAs, routine calls, relative update) via the nurse in charge; communicate delays and document decisions for continuity and governance.

A bit more (from the episode)

• Concurrent actions matter: Calling for help en route accelerates definitive care without delaying bedside assessment.

• Professional tone: Don’t dismiss colleagues (e.g., Radiology); defer politely and route via the nurse in charge.

• Relatives & confidentiality: Arrange a call-back with proper ID/consent rather than splitting attention during an emergency.

• Avoid unsafe shortcuts: Remote warfarin advice without assessment is risky; defer safely and review properly.

• Documentation protects patients and you: Record who was informed, what changed, and why.

Key takeaways

• TRIAGE: Treat the sickest first (ABCDE) → Raise help early (2222/SBAR) → Insulate non-urgent tasks → Acknowledge delays → Guidelines (NEWS2/NICE) → Enter clear notes.

• Patient safety > admin targets.

• Communicate, escalate, document.

• 📎 More MSRA resources to accompany this episode:

  • https://www.passthemsra.com/

  #MSRA #MSRASJT#CopingUnderPressure #Prioritisation #ABCDE #NEWS2 #GMC #Teamworking#Escalation #SBAR #NHS

  Correct choices (Priority — best three): 1, 2, 3

Episode Transcript

(00:00):
Welcome back to the Deep Dive. If you're prepping for the
MSRASJT, you know it's not just about the medicine, is it?
It's often about juggling, well,everything at once.
Exactly. And today we're tackling a
classic high stakes situation, clinical prioritisation under
pressure. You know, the competing bleep
scenario everyone dreads but needs to master.

(00:20):
Yeah, it really tests your ability to think clearly when
things are hitting the fans. So this is a priority question.
Remember, that means you'll see eight options, and your job is
to pick the three most appropriate actions.
That's the task. It's about immediate safety and
professional conduct, pulling onthose core GMC principles.
Absolutely. So maybe grab a pen and paper if
you haven't already. Let's dive into this evening

(00:42):
shift scenario. OK, picture this.
You're the medical SHO, it's early evening, you're covering 2
wards and suddenly bang, 5 things land on you all at the
same time. Right, first up, the big one, a
nurse calls you 72 year old patient, no pneumonia now
they're acutely short of breath.Sats are 82% on air.
Wow. OK, 82% on air.

(01:02):
That's yeah, that's an immediateemergency alarm bell right
there. Definitely.
Then almost simultaneously the Ed rings, they need Ttas, the
discharge summaries for a stablepatient, and they say they need
them like in 30 minutes because of patient flow pressures.
The classic admin squeeze alwaysfeels urgent, doesn't?
It it does third thing, radiology phones.

(01:23):
It's about a routine outpatient ultrasound result.
Query seems pretty non urgent compared to the others.
OK, 4th. Your FY one flags you down.
They need you to check a warfarin dose before 6:00 PM.
They're not sure about it. Right.
A prescribing check important, but is it immediately life
threatening? We'll see.
And finally #5 switchboard patches through a call.

(01:44):
It's a relative wanting an update on a patient.
OK, so a real mix there, A clearemergency admin pressure routine
stuff, a junior needing help in communication.
Now the context is also key, isn't it?
Yes, absolutely. You're told the nurse in charge
can help you out with some things.
Your medical registrar is contactable, though busy, and
crucially, the ALS team or the 2222 emergency number is

(02:06):
available right? So you're not completely alone,
but you were the 1 making the initial decisions, the task.
Again, pick the three most appropriate actions to take
right now. OK, let's run through the
options. Think carefully what has to
happen immediately. Option one, go immediately to
assess the hypoxic patient, start an ABCDE assessment, give
oxygen according to protocol andask for Obs and a VBG.

(02:29):
Option two, Call 2222 ALS or themedical Registrar for urgent
support while you're on your wayto the hypoxic patient giving a
concise SBI handover. Option three, ask the nurse in
charge to pause or redirect yournon urgent bleeps.
Let E know the Ttas will be delayed and document that you've
reprioritized. Option 4 Prioritise writing the

(02:50):
Ed discharge Ttas first because you know patient flow targets
have to be met. Option 5 Tell the FY1 just to
hold the warfarin dose for now and you'll review it later, but
you don't actually assess the patient yourself first.
Option 6. End the call with radiology by
telling them to ask the GP instead because it's not urgent
for you right now. Option 7 ask the ward clerk to

(03:11):
take the relatives details, reassure them someone will call
back later, and make sure the team does consent and ID cheques
before any info is given. And finally, option 8, advise
the nurse looking after the hypoxic patient to only escalate
to outreach or critical care if the patient actually arrests OK.
Eight options, Which three are the absolute must do's?

(03:33):
Take a moment. Now really think about that
patient with 82% sats. What needs to happen now for
safety and good practise? We'll pause for a second.
All right, let's see how you did.
What are the top three actions here?
The three best options, the onesthat cover immediate safety and
professional responsibility, are1-2 and three.
OK, 1-2 and three. So that's immediate assessment,
immediate escalation, and immediately getting control of

(03:55):
the other tasks. Let's unpack why these three
work together, starting with #1.Well, actually one is non
negotiable, isn't it? You have a patient who is
critically hypoxic. Speedos 82% on air is frankly
terrifying. Patient safety is always
paramount. That's GMC one O 1.
So you have to go immediately. And what do you do when you get
there? You start the ABCDE approach.

(04:17):
That's the standard for any acutely unwalled patient.
Getting oxygen on, getting baseline Obs thinking about a
gas. Yeah.
That's step one in stabilising. Makes total sense you have to
deal with the immediate life threat first, but then action 2
calling for help while on route.I asked this before, but isn't
there a risk that fiddling with your phone delays you getting to

(04:38):
the bedside? Shouldn't you get there, assess,
then call? It's a really good question
because it feels counterintuitive sometimes, but
think about it. Severe hypoxia like this
suggests the patient might deteriorate very rapidly.
They might need interventions you can't provide alone, like
intubation. Calling 2222 or your Reg as

(04:59):
you're moving means the cavalry is alerted sooner.
Those couple of minutes you saveby initiating the call early
could be absolutely crucial for getting advanced help to the
patient faster. It's a concurrent activity in an
emergency. I see.
So it's not delaying the assessment, it's speeding up the
definitive response and the SPR part.
Why is that specifically mentioned?
Because in a crisis, communication needs to be
crystal clear and efficient. SPR situation background

(05:23):
assessment recommendation gives you that structure.
When you call The Reg or hand over to the crash team you can
quickly say situation. 72 yo, hypoxic SAT, 82% background, no
pneumonia assessment, acutely short of breath.
I'm on my way. Recommendation requesting urgent
review. ALS attendance.
No waffle, just the critical facts.

(05:44):
It's safe, professional communication under pressure.
Got it. OK, So we're assessing and
escalating simultaneously. Now action three, asking the
nurse in charge to manage other bleeps, Telling EB about the
delay, documenting why is this administrative management part
of the top three immediate actions?
Because if you don't do this, the chaos continues.
Those non urgent beliefs, the radiology query, maybe even the

(06:06):
relative call initially will keep interrupting you while
you're trying to manage a critically I'll patient.
Right, you need focus. Exactly.
You need to insulate yourself and the immediate situation.
Asking the nurse in charge to intercept non urgent calls is
sensible delegation. Critically though, you must
communicate the delay, especially the Ed, regarding the
Ttas. Just ignoring them is

(06:29):
unprofessional and unsafe for patient flow down the line.
And documenting your decision toreprioritize is vital for
accountability. It shows you made a conscious,
justifiable decision based on clinical need.
It protects you, the patient, and it forms the team.
It's about managing the system safely, not just the patient in
front of you. That makes sense.
It's proactive control rather than reactive firefighting.

(06:51):
So that's why 1-2 and three are the priorities.
Let's quickly look at why the others are wrong or less
appropriate. Option 4.
Doing the TT as first. That's a huge red flag isn't it?
Prioritising administrative targets like patient flow over a
patient with life threatening hypoxia that fundamentally
breaches your duty of care. It's dangerous and absolutely
incorrect. To the question, OK, option 8,

(07:12):
telling the nurse to only escalate if the patient.
Also incredibly dangerous escalation for hypoxia needs to
be preemptive based on the deterioration, not waiting for a
catastrophic event like an arrest that goes against all
guidelines on recognising and responding to the acutely I'll
patient. Definitely incorrect.
Right now, option 5, telling theFY1 to just hold the warfarin

(07:34):
without seeing the patient or knowing why the FY1 is asking
you flag this as unsafe. Why exactly?
Because holding a dose is a prescribing decision, making
that decision without any clinical context.
Why is the FY1 unsure? What's the patient's INR?
What's their bleeding and clotting risk is unsafe?
You're essentially giving remoteadvice without assessment.
What if the reason the FY1 was worried was valid and holding

(07:57):
the dose causes a clot? Or what if holding it was wrong
and they needed it? You haven't properly supervised
your junior or taken responsibility for that clinical
decision. It's an unsafe shortcut.
So it's not just about the warfarin itself, it's about the
lack of assessment and supervision.
Precisely. You need more information before
making or advising on that decision.
Even if it seems minor compared to the hypoxic patient, that

(08:20):
task needs safe deferral and proper review later.
OK. And the last two, six and seven,
the radiology call and the relative.
Well, action 7, asking the word clerk to manage the relatives
call is actually good practise in itself.
It delegates appropriately, ensures a callback, mentions
consentity cheques. It's the right thing to do with
that call eventually, but it's not one of the top three

(08:42):
priorities. When someone sats or 82%, it can
be safely deferred. Appropriate but not immediate
priority and action 6 being abrupt with radiology that's.
Just poor professionalism, isn'tit?
While the query isn't urgent foryou right now, telling a
colleague to basically go away and ask the GP is just
respectful. Option 3 covers this better,
politely deferring non urgent tasks via the nurse in charge,

(09:03):
or handling it yourself briefly once the immediate crisis
allows. So action 6 is less appropriate
because of the unprofessional manner.
Right. That makes the ranking clear.
So distilling this down, what are the key takeaways for
listeners facing these prioritisation questions?
OK, three main things. I think first patient safety,
Trump's everything that's be aware of. 82% dictates your

(09:25):
immediate action. Always go back to the ABCDE
approach. That's non negotiable.
Got it, ABCD. First second, escalate early and
effectively. Don't wait for things to get
worse. Use your team The Reg, the Crash
team via 2222 ALS and use structured communication like
SBR when you do. It's about teamwork and
recognising your limits. OK, early escalation.

(09:47):
And 3rd manage the chaos safely.You have to deal with the non
urgent stuff, but do it by safe deferral.
That means communicating the delay to those affected and
documenting your decision to reprioritize.
That shows accountability. O assess, escalate and control
the environment. That seems like a solid
framework. You can almost think of it like
triage, but extended. Treat the sickest first.

(10:08):
Action one raise help early. Action 2 Insulate from non
urgent tasks. Action 3V delegation,
communication. Acknowledge delays and document
clearly. That's a great way to remember
it. Keep practising these types of
questions everyone. Getting that muscle memory for
prioritisation is key for the SJT.
Definitely. And keep those GMC principles,
patient safety, working with colleagues, communication,

(10:31):
record keeping at the front of your mind.
You've got this. Before we finish, just a quick
thought to leave you with going back to that Warfare inquiry
option 5. If you had to give some initial
advice remotely in that situation, which we've
established is risky, what absolute bare minimum questions
would you need to ask the FY1 first, just to cover yourself
even slightly? Something to ponder about remote

(10:52):
decision making under pressure. Good point, we'll catch you on
the next team dive.