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Monitor at the facility or send resident to the hospital?

Across
Residents systolic and diastolic and both in the high 200 and they are lethargic
A resident is SOB and O2 is 90%, they have COPD and this is close to their baseline
A residents vitals are slightly elevated
Down
Resident had a bad fall and you see blood
A resident had a hard fall and cannot move their leg
Resident fell but they are able to get up by themselves and ROM is normal