TRIAGE Goals of Triage Rapidly identify patients with

TRIAGE Goals of Triage Rapidly identify patients with

TRIAGE Goals of Triage Rapidly identify patients with urgent, life-threatening conditions Assess/determine severity and acuity

of the presenting problem Direct patients to appropriate treatment areas Re-evaluate patients awaiting treatment Advantages of Triage

Streamlines patient flow. Reduces risk of further injury/deterioration. Improves communication and public relations. Enhances teamwork. Identifies resource requirements. Establishes national benchmarks. Triage Acuity Determinants Chief complaint.

Brief triage history. Injury or illness(signs & symptoms). General appearance. Vital signs. Brief physical appraisal at triage. Triage Role To determine severity of illness or injury for each patient who enters the Emergency Department

(ED). Triage Patients should have a triage assessment within 10 minutes of arrival in the ED. Accurate triage is the key to the efficient operation of an emergency department.

Effective triage is based on the knowledge, skills and attitudes of the triage staff. Triage Process Assess and determine the severity or acuity of the presenting problem.

Process the patient into a triage level. Determine and direct the patient to appropriate treatment areas. Effectively and efficiently assign appropriate human health resources. Triage Assessment Chief complaint. Brief triage history Injury or illness (signs & symptoms) General appearance. Vital signs. Brief physical appraisal at triage.

5 Level Triage Level Level Level Level Level

1 2 3 4 5 Resuscitative Emergent Urgent Less urgent Non-urgent

Triage is a dynamic process. Reassessment & Reassessment . A patients condition may improve or deteriorate during the wait for treatment. Level I: Resuscitative

Conditions that are threats to LIFE or LIMB (or imminent risk of deterioration) requiring aggressive interventions. Time to MD: Immediate Time to Nurse: Immediate

Continuous reassessment Level I Usual presentations Code / arrest. Major trauma. Severe burns--airway compromise . Shock states.

Severe respiratory distress. Near death asthma (Status asthmatics). Tension pneumothorax. Altered mental state. Seizure (Status epileptics). Traumatic shock. Overdose. AAA.

AMI with complications. Congestive heart failure with low BP. Major head injury-unconscious. Level II Emergent Conditions that are a potential threat of life, limb or function, requiring rapid medical intervention or delegated acts.

Time to MD: 15 minutes. Time to Nurse: immediate. Reassessment time: 15 minutes. Level II Emergent

Usual presentation

Chest Pain Query MI Trauma Chemical Exposure Stroke Altered Consciousness Acute MI Severe Asthma-stridor Acute Psychotic Episode with Agitation Severe Pain 8 -10 Reassessment 15 mins Level III Urgent

Conditions that could potentially progress to a serious problem requiring emergency intervention. May be associated with significant discomfort or affecting ability to function at work or activities of daily living. Time to MD: <30 minutes.

Time to Nurse: 30 minutes. Reassessment time: 30 minutes Level III Urgent Usual presentations:

Renal colic, billary colic GI bleed with normal VS Previous seizurealert Dehydration.

Shunt dysfunction. Vital signs outside normal range. Pain scale 4 -7 \10 Moderate risk of harm to self or others. Inconsolable infant , infant not feeding. Behavior change. Reassessment 30 minutes Level IV: Less Urgent Conditions that related to patient age, distress, or potential for deterioration or

complications would benefit from intervention or reassurance within (1 2 hours) Time to MD < 60 minutes (1 hr) Time to Nurse < 60 minutes (1 hr)

Reassessment time: 60 minutes (1 hr) Level IV: Less Urgent Usual presentation:

Head injuryalert. Earache. Abdominal pain. UTI sign and symptoms. Simple laceration requiring sutures. VS normal Reassessment 1 hour Level 5: Non Urgent Conditions that may be acute but non-urgent as

well as conditions which may be part of a chronic problem with or without evidence of deterioration. The investigation or interventions could be delayed or even referred to other area of the hospital or health care system. Time to MD: 120 minutes.

Time to Nurse: 120 minutes. Reassessment time: 120 minutes Level 5: Non Urgent Usual presentation:

Strains. Sprains. Single episode of vomiting. Sore throat. Script refills. Chronic problems with no change.

Investigation or intervention for these illnesses or injuries could be delayed or even deferred. Reassessment 2 hours \120 minutes Pediatric Triage PCTAS There are three things that must be assessed and documented on all pediatric patients:

Respiratory rate. Heart rate. Capillary refill. Pediatric CTAS Poster Pocket Card Pediatric Vital Signs Must include:

Heart rate. Blood pressure. Respiratory rate. O2 saturation. Temperature. Capillary refill. Accurate weight!

Vitals Are Your Safety Net. Less Urgent and Non Urgent patients have NORMAL vital signs. Abnormal vital signs are at least an URGENT.

Triage is a dynamic process A patients condition may improve or deteriorate during the waiting for treatment Reassessment, Reassessment, Reassessment

Triage Practical Injury Prevention Injury prevention practical General Approach to POISONED Patient ABCsIV, O2, monitor

History

Decontaminate if organophosphates prior touching by health care professionals Lily kit for cyanide poisoning. Obtain all prescription and bottles in the household (call pharmacy). Pill count. PM Hx. Search clothes for clues, medication alerts, pills etc. Contact family members. Track marks, consider body packing or stuffing. Vital signs, Rhythm strip.

General approach to poisoned pt. What are the essential features of a 30-second toxicological exam? Vital signs- HR, RR, BP. Temperature- rectal (resp rate can affect oral temperature). Skin- color, temperature, and sweating. Odors- provide clues (their absence means nothing)

Bowel sounds and bladder function. Mental status. General approach to poisoned pt Tests GI Decontamination

Activated Charcoal Antidotes Practical

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