Instructions | CFRs Live

Instructions for using the app

There is much to explore in the app, but here are some pointers and bits of interest.

Sounds

The app makes various sounds.

Pip: some new content has appeared (e.g. if you choose a presenting complaint, you will here a little "pip" noise and a Treatment tab appears.

Warbling: you have been taken to a new tab (e.g. if you choose pt not breathing, you are taken to the BLS tab)

Boop-boop: you have entered an incorrect value, e.g. enter an age of "twenty" won't work.

Beep-beep-beep: there is a new alert that you must acknowledge, e.g. an observation is out of the normal range.

Signing in

You must sign in with a Google account. We receive your email address. No further data is sent outside the app.

Hamburger menu (☰)

The hamburger menu (☰ on the top bar) contains options relevant to where you are in the app, e.g. delete all patient data, delete one patient data, sign out, etc.

New patient

Click New patient to start a new patient session. The data will be stored in the app for 24 hrs after you last use it. After 24 hrs the data is deleted irrecoverably.

Pt details

On the Pt details tab there are a few parameters. You can enter name. This is just an aide memoire for you.

You can choose Gender. For female you can choose whether the pt is pregnant, as this will vary algorithms.

You can enter Age. You enter this either as a number of years or as a number of days, weeks or months. You do this by suffixing "d", "w" or "m" to the number, e.g.

Once you enter an age, a Page per Age tab will appear.

Finally, you can choose the Presenting complaint. You can change this at any time or choose more than one. If the precise presenting complaint isn't listed, you can choose Other and enter the p/c.

The app attempts to give you basic treatment information on the Treatment tab. Not all p/cs have treatment available (e.g. SVT), because in our trust there is little the CFR can do. This might be different in your trust or group, so please give us feedback if you would like treatment notes changed.

Once you enter all mandatory fields (denoted by *), then the Primary tab will appear for you to start your primary survey. Note that no other tabs will appear until the primary survey is complete.

Full or essential mode

The app runs in "Full" mode by default, but you can choose essential mode by clicking the ABCDE+Obs button. This prompts you for minimal data and is a quick way to capture observations and little else.

Tabs

Tabs will appear according to the questions you answer and the choices you make in the app. For example, if you choose Breathing difficulty as p/c then a Breathing tab appears; if you enter an age 12 or under, the PAT tab appears.

Word & phrase detection

If you enter notes anywhere on patient tabs, the app will detect them. For example, if the pt mentioned that he or she has asthma and you make a note of that, the Breathing and Asthma tabs will appear automatically.

Mandatory fields

As mentioned above, mandatory fields are denoted by an asterisk (*) next to them. The app does not prevent you from moving on, but any tab with an empty mandatory field will have a red dot on the tab.

Information popups

Some fields have a ⓘ symbol next to them. This denotes that more information is available. For example, the Response (AVPU) dropdown will pop up the "FISHSHAPED" mnemonic when you tap the ⓘ symbol; the Sats obs input has a popup with mask choices and O₂ flow rates; the PERRL yes/no input has a popup with causes of pupil size change.

There is an OK button at the end of each popup to close it.

Observations

As soon as the primary survey is completed, an Obs 1 tab appears, which is for the first set of observations. Any obs you enter as part of the primary or secondary survey (or any of the additional tabs such as breathing) will also populate the fields in Obs 1.

New set of obs

Click the hamburger menu (☰), then New observations to add another set of obs at any time.

Entering obs

You can enter any / all of the obs. If an observation is out of the normal range (dependant on the pt's age), you will receive an alert.

Tapping HR / RR

Heart rate and respiration rate can be entered as a number, or by tapping in time. Click the target icon (⦾) next to the field and you'll get a popup that allows you to tap each time you feel a pulse or observe a breath. Click OK when you're done, to close the popup and populate the relevant field.

Copying observations to send to clinician

At the bottom of each Obs tab is a summary of the obs, including their sequence (Obs #1, Obs #2, etc). Tap the clipboard icon (📋) to copy this summary. You can then paste it into NMA or other software, to send to a clinician.

NEWS2

When you enter a set of obs, the app will calculate the pt's NEWS2 score, giving you an appropriate alert and reminding you when the next set of obs should be taken.

Obs list

As soon as you start entering observations, an Obs list tab appears. This will show all the observations you've captured to-date.

Alerts

As you collect observations and other data, alerts may be triggered. The first one you're likely to see is a warning that NEWS2 can not be used for paediatric patients. This appears on the Pt details tab when you enter an age under 16.

The alerts appear in situ on tabs, but are also added to an Alerts tab. Some alerts (more important ones) will make a warning sound and must be acknowledged. These alerts have an OK button on them. Tapping this will silence the alert.

If you can't readily see the alert (it may be on a different tab) check the Alerts tab, as all alerts will be shown there too.

If there are new alerts on the Alerts tab, a warning triangle (⚠) will be shown on the tab.

Some alerts are shown from a combination of tabs, or sets of obs. For example a warning about Cushing's Triad will show when detected, but two sets of obs would be needed for this.