TRIAGE Goals of Triage n n Rapidly identify

TRIAGE

Goals of Triage n n 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 n n n 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. n Brief triage history. Injury or illness(signs & symptoms). n General appearance. n Vital signs. n Brief physical appraisal at triage. n

Triage Role • To determine severity of illness or injury for each patient who enters the Emergency Department (ED).

Triage n Patients should have a triage assessment within 10 minutes of arrival in the ED. n Accurate triage is the key to the efficient operation of an emergency department. n Effective triage is based on the knowledge, skills and attitudes of the triage staff.

Triage Process n n 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. n Brief triage history Injury or illness (signs & symptoms) n General appearance. n Vital signs. n Brief physical appraisal at triage. n

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

n Triage is a dynamic process. n Reassessment & Reassessment. n A patient’s condition may improve or deteriorate during the wait for treatment.

Level I: Resuscitative n Conditions that are threats to LIFE or LIMB (or imminent risk of deterioration) requiring aggressive interventions. n Time to MD: Immediate n Time to Nurse: Immediate n Continuous reassessment

Level I n Usual presentations Code / arrest. n Major trauma. Severe burns--airway compromise. n Shock states. n Severe respiratory distress. Near death asthma (Status asthmatics). Tension pneumothorax. n Altered mental state. n Seizure (Status epileptics). n Traumatic shock. n Overdose. n AAA. n AMI with complications. n Congestive heart failure with low BP. n Major head injury-unconscious. n

Level II Emergent n Conditions that are a potential threat of life, limb or function, requiring rapid medical intervention or delegated acts. n Time to MD: 15 minutes. n Time to Nurse: immediate. n Reassessment time: 15 minutes.

Level II Emergent n Usual presentation n n 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 n n 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. n Time to MD: <30 minutes. n Time to Nurse: 30 minutes. n Reassessment time: 30 minutes

Level III Urgent n Usual presentations: n n n n n Renal colic, billary colic GI bleed with normal VS Previous seizure—alert 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 n Conditions that related to patient age, distress, or potential for deterioration or complications would benefit from intervention or reassurance within (1 – 2 hours) n Time to MD < 60 minutes (1 hr) n Time to Nurse < 60 minutes (1 hr) n Reassessment time: 60 minutes (1 hr)

Level IV: Less Urgent n Usual presentation: n n n n Head injury—alert. Earache. Abdominal pain. UTI sign and symptoms. Simple laceration requiring sutures. VS normal Reassessment 1 hour

Level 5: Non Urgent n n 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. n Time to MD: 120 minutes. n Time to Nurse: 120 minutes. n Reassessment time: 120 minutes

Level 5: Non Urgent n Usual presentation: n n n n 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 n There are three things that must be assessed and documented on all pediatric patients: n n n Respiratory rate. Heart rate. Capillary refill.

Pediatric CTAS Poster Pocket Card

Pediatric Vital Signs n Must include: n n n n Heart rate. Blood pressure. Respiratory rate. O 2 saturation. Temperature. Capillary refill. Accurate weight!

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

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

Triage Practical

Injury Prevention

Injury prevention practical

General Approach to POISONED Patient n ABCs…IV, O 2, monitor n n n History n n n n 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? n Vital signs- HR, RR, BP. n Temperature- rectal (resp rate can affect oral temperature). n Skin- color, temperature, and sweating. n Odors- provide clues (their absence means nothing) n Bowel sounds and bladder function. n Mental status. n

General approach to poisoned pt n Tests n GI Decontamination n n Activated Charcoal Antidotes

Practical