Triage basics
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Triage basics

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Presentation on the basics of Triage for the Emergency Nurse working in Australian Emergency Department.

Presentation on the basics of Triage for the Emergency Nurse working in Australian Emergency Department.

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  • RR greater than 27 biggest indicator of in hospital cardiac arrest
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Triage basics Triage basics Presentation Transcript

  • Triage BasicsBy Kane Guthrie FCENA
  • Learning Points• Triage- What is it• The Australian Triage Scale• Triage assessment• Predictors of poor outcome• Red flags at triage• Assigning appropriate ATS
  • Triage Trier= to sort. Triage= establishing priorities of patientcare for urgent treatment while allocatinglimited resources.
  • Triage Timely response to abnormal clinicalfindings reduce morbidity & mortality. National Triage Scale (1993-1997) Australasian Triage Scale (1997-present)
  • The ATS An assessment tool allowing for:– Timeliness– Fairness– Consistency– Time to treatment– Performance appraisal
  • Time-2-Treatment
  • Physiological Predictors
  • Looking for the @Risk• Risk Factors for serious injury/illness
  • Waiting is Bad
  • Access Block• Hospital wide issue• Burden is with ED• ∧Morbidity & Mortality• Huge impact at triage– Ramping– WR management
  • Predictors of Bad Outcomes!• Physiological abnormalities• Failure to recognise & treat• Age >65
  • Know Your Environment
  • Making Decisions @ TriageInterpret∨Discriminate∨Evaluate
  • Assessment @ TriageIts all about:• Airway• Breathing• Circulation• Disability• Exposure/Environment
  • The Approach
  • AirwayAlways check patency– Consider C-Spine precautions• Occluded or compromised airway=ATS 1
  • The C-SpineNexusMOI with 1 Criteria:• Cervical tenderness• Signs of intoxication• Altered Mental state• Significant distracting injury• Focal neurological deficitsCanadian• Only use when GCS 15
  • BreathingAssessment includes:– Resp Rate– Work of Breathing• Detecting hypoxia is paramount!
  • CirculationAssessment includes:– Heart rate– Pulse & pulse characteristics– Cap refill• Signs of haemodynamic compromise=ATS 1 or 2
  • DisabilityAssessment includes:– Use AVPU or GCS• Signs of altered level of consciousness=Important indicator of serious injury/illness
  • EnvironmentAssessment Includes:– Assess Temperature• Hypo/hyperthermia are important indicatorsof serious illness!
  • PAIN
  • “The eye’s don’t seewhat the minddoesn’t know!”
  • General AppearanceLook for:– Observe mobility– Does the patient look sick?– Behaviour– Ability to use vending machine
  • The Eyes
  • Some Pearls&Pitfalls
  • “Trust your instincts notthe paramedics!”
  • Extremes of Age• Be aware:• Physiological differences, limited reserves
  • High Risk Features• Chronic Illness• Cognitive impairment• Co-morbidities• Poisonings• Severe pain• Use caution allocate higher ATS
  • High Risk Alerts
  • Trauma Patients• Look at MOI:– Vehicle rollover– Death in same vehicle– Ejection– Fall from >3 meters• Use trauma criteria = ATS 1 or 2
  • The Rashes
  • When Multiple Patients Arrive!• Look for compromised A,B,C• Get SJA to triage themselves• Do a mini triage & priorities
  • Managing the WR• Use clinical rounding– Reassess and retriage if need– Treat pain– Manage the families
  • Patient 1
  • Patient 2• 80 male• Post fall- GCS 15• On Pradaxa
  • Patient 3• BIBP –intoxicated-homeless• Obstructive & belligerent
  • PEARL• “Alcoholics were puthere to burn triagenurses”
  • Patient 4• 20 male• Playing with nail gun• Got nailed!
  • Patient 5• 60 Male• COPD• RR30, Sp02 95%, HR 110
  • Questions
  • Take Home Points• ID & Manage risk to self & patients• 1st impressions count• “Does the patient look sick?”• ID time critical interventions required• Use the Duty consultant & SCO• The waiting room is your enemy!
  • Thank you