Triage basics
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Triage basics



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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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