Handoff Example
You just saw the following patient:
HPI: John Smith is a 3yo M presenting with increased work at breathing throughout the day. Has had cough x2 days but worse today. This morning when woke seemed to be working harder to breathe.
Given albuterol inhaler with spacer with some improvement initially. Now requiring albuterol every 2 hours at home. Some runny nose. No cough. Good oral intake. Normal UOP. No vomiting. No fever.
No choking events. No exposure to cats and no history of anaphylaxis. Sister had similar symptoms earlier in the week.
PMH: History of wheezing with viral illness for which he sometimes improves with albuterol. No asthma diagnosis. No controller medication. Was admitted about 2 months ago for similar symptoms but has never been intubated. Has eczema. Had UTI as infant but subsequent imaging of kidneys was normal.
No other recurrent infections. Buckle fracture of radius last year.
ROS: Negative other than HPI.
PMD: Dr. Jones (C-DOC attending)
SurgHx: None
Medicines: Albuterol as needed
Allergies: Cats
Immunizations: UTD
FHx: Mother had asthma as a child. No ill contacts in the home.
SocHx: Lives at home with parents and sister. Dad smokes. There is a dog in the home. Attends daycare.
Exam on Presentation:
T 37.6 C, HR 140, RR 48, O2 Sat 93% on RA, BP 96/58
Gen: Alert, moderate respiratory distress. Will not talk in full sentences.
HEENT: NCAT. PERRL. TM clear bilaterally. Scant thick rhinorrhea. Throat with minimal erythema but no palatal petechiae and no exudates.
Neck: No LAD.
CV: RRR. No murmurs, rubs, or gallops.
Pulm: End expiratory wheezes bilaterally with poor air entry at the bases. Intercostal retractions. No crackles.
Abd: Soft, NDNT. No HSM.
GU: Deferred
Back: Normal alignment
Skin: No rashes nor bruises

A/P: 3yo M c history of wheezing here with increased work at breathing. Exam and history consistent with viral induced wheeze vs. asthma exacerbation (as patient has multiple environmental triggers in the home)
- Albuterol
- Reassess
ED Course: You reassess the patient after the above treatment and he continues to wheeze. He is then given Orapred and two duonebs with some improvement of symptoms. It’s almost time to sign-out so you start the patient on an hour continuous albuterol and go to sign-out.
Below would be an example of how to handoff this patient using the LURIES mnemonic:
One-Liner
Update
Review
Identify issues
Expectant management
Synthesis/Send
John Smith is a 3yo M with history of viral induced wheeze here with cough and wheeze x2 days.
He has received albuterol, Orapred, and duoneb x2. I just started him on a continuous albuterol treatment.
He needs to be reassessed in about 30 minutes at 7:30am to see how he sounds.
I anticipate he’ll still be wheezing and will likely need to be admitted to the MOU for weaning albuterol.
He is a CDOC patient and I have not talked to his PMD yet regarding if they would prefer to have him admitted to their service or if they are ok with him going to the MOU. There are
MOU beds available last I checked. If they ask, we did not get a
CXR because he has a history of wheeze, no fever, and known viral contact.
In sum, this is a 3yo M with presumed viral induced wheeze, likely reactive airway as well, that I anticipate will need to be admitted to the MOU for weaning albuterol
Below would be an example of how to receive handoff for this patient using the 3Ss mnemonic:
Summarize patient
State what will be completed
John Smith is a 3yo M with viral induced wheezing and probably reactive airway disease now s/p albuterol, Orapred, and duoneb x2 on continuous albuterol.
I’ll go listed at 7:30am and if still wheezing will likely admit for obs.

Send (disposition) plan stated
If wheezing, I will call PMD and then call MOU attending for admission to MOU for obs.