Many Type of Triage in ER Triage acuity

Many Type of Triage in ER

Triage acuity system 2 level Emergent Non Emergent 3 level Emergent Urgent Non Urgent 0 -20 mins 20 -60 mins > 60 mins 5 level Resuscitation/ immediate life threatening Emergent Urgent Semi Urgent Non Urgent Immediately <10 mins 10 -30 mins 30 -60 mins >60 mins 4 level Life-threatening Immediately Emergent 5 -15 mins Urgent 15 -45 mins Non Urgent 1 -2 hrs ระยะเวลาจะเปลยนแป ลงตามระบบคดกรองต างๆ

TRIAGE ตวอยางการคดแยก 5 ระดบ Australasian triage System (ATS) Canadian triage and acuity scale (CTAS) Manchester triage scale Emergency severity Index (ESI)

Canadian triage and acuity scale (CTAS) พฒนาจาก Australasian triage System (ATS) เอา Pain score มาใชรวมดวย

Emergency severity Index (ESI)

Emergency Severity Index (ESI) How to Use ESI ?

1 ผปวยใกลตาย ? (ตองมมาตรการรกษาชวต ) Table 2 -1. Immediate Life-saving Interventions Life-saving Not life-saving Airway/breathing • BVM ventilation • Intubation • Surgical airway • Emergent CPAP • Emergent Bi. PAP Oxygen administration • nasal cannula • non-rebreather Electrical Therapy • Defibrillation • Emergent cardioversion • External pacing Cardiac Monitor Procedures • Chest needle decompression • Pericardiocentesis • Open thoracotomy • Intraoseous access Diagnostic Tests • ECG • Labs • Ultrasound • FAST Hemodynamics • Significant IV fluid resuscitation • Blood administration • Control of major bleeding • IV access • Saline lock for medications Medications • Naloxone • D 50 • Dopamine • Atropine • Adenosine • ASA • IV nitroglycerin • Antibiotics • Heparin • Pain medications • Respiratory treatments with beta agonists

1 ผปวยใกลตาย ? (ตองมมาตรการรกษาชวต ) Table 2 -1. Immediate Life-saving Interventions Airway/ Breathing Life-saving Not life-saving • Intubation • Surgical airway • Emergent CPAP • Emergent Bi. PAP Oxygen administration • nasal cannula • non-rebreather

1 ผปวยใกลตาย วต ) ? (ตองมมาตรการรกษาช Table 2 -1. Immediate Life-saving Interventions Life-saving Electrical Therapy • Defibrillation • Emergent cardioversion • External pacing Not life-saving Cardiac Monitor

1 ผปวยใกลตาย ? (ตองมมาตรการรกษาชวต ) Table 2 -1. Immediate Life-saving Interventions Life-saving Procedures • Chest needle decompression • Pericardiocentesis • Open thoracotomy • Intraoseous access Not life-saving Diagnostic Tests • ECG • Labs • Ultrasound • FAST

1 ผปวยใกลตาย ? (ตองมมาตรการรกษาชวต ) Table 2 -1. Immediate Life-saving Interventions Life-saving Hemodynamic • Significant IV fluid resuscitation • Blood administration • Control of major bleeding Not life-saving • IV access • Saline lock for medications

1 ผปวยใกลตาย ? (ตองมมาตรการรกษาชวต ) Table 2 -1. Immediate Life-saving Interventions Life-saving Medications • Naloxone • D 50 • Dopamine • Atropine • Adenosine Not life-saving • ASA • IV nitroglycerin • Antibiotics • Heparin • Pain medications • Respiratory treatments with beta agonists

1. Resuscitation ตวอยาง case Resuscitation Cardiac arrest Airway Breathing Circulation Disability ใส ETT, FB อดตน ทสงผลตอการหายใจ pneumo/hemothorax, หอบมาก อกบม + O 2 sat drop , Anaphylaxis , หายใจชามาก Shock Tachyarrythmia, VF , VT, SVT, Heart block, AF ไม stable , MI ทเหงอแตกตวเยน (poor perfusion) Multiple trauma Active bleeding BP drop ซมมากตงแต semi-coma , severe head injury , status epilepticus )ไมวาจะใสเองหรอ refer มา) ใส ICD จำเปนตองชวยหายใจ ทตอง cardioversion ทฉด adenosine on external pacemaker ทซดมาก , BP drop , ตองรบ load iv fluid ตองรบ stop bleed load iv fluid

1. Resuscitation ตวอยาง case Resuscitation • Cardiac arrest • Respiratory arrest • Severe respiratory distress • Sp. O 2 < 90 • Critically injured trauma patient who presents unresponsive • Overdose with a respiratory rate of 6 • Severe respiratory distress with agonal or gasping type respirations • Severe bradycardia or tachycardia with signs of hypoperfusion • Hypotension with signs of hypoperfusion

1. Resuscitation ตวอยาง case Resuscitation • Trauma patient who requires immediate crystalloid and colloid resuscitation • Chest pain, pale, diaphoretic, • Weak and dizzy, heart rate = 30 • Anaphylactic shock • Baby that is flaccid • Unresponsive patient with a strong odor of alcohol • Hypoglycemia with a change in mental status • Intubated head bleed with unequal pupils • Child that fell out of a tree and is unresponsive to painful stimuli

2. Emergency Examples of patients who are confused, lethargic, or disoriented onset of confusion in an elderly patient The 3 -month-old whose mother reports the child is sleeping all the time The adolescent found confused and disoriented

2. Emergency In some patients Pain can be assessed by clinical observation Distressed facial expression, grimacing, crying Diaphoresis Body posture Changes in vital signs – hypertension (HTN), tachycardia, and increased respiratory rate

No body Perfect PRACTISE and PRACTISE !!!!!

การ Triage ใหเหมาะสม q Knowledge q Experience q Skill q Attitude Re-Triage

The End