Triage basics
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Presentation on the basics of Triage for the Emergency Nurse working in Australian Emergency Department.
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Triage basics
- 1. Triage Basics By Kane Guthrie FCENA
- 2. Learning Points • Triage- What is it • The Australian Triage Scale • Triage assessment • Predictors of poor outcome • Red flags at triage • Assigning appropriate ATS
- 3. Triage Trier= to sort. Triage= establishing priorities of patient care for urgent treatment while allocating limited resources.
- 4. Triage Timely response to abnormal clinical findings reduce morbidity & mortality. National Triage Scale (1993-1997) Australasian Triage Scale (1997-present)
- 5. The ATS An assessment tool allowing for: – Timeliness – Fairness – Consistency – Time to treatment – Performance appraisal
- 8. Looking for the @Risk • Risk Factors for serious injury/illness
- 10. Access Block • Hospital wide issue • Burden is with ED • ∧Morbidity & Mortality • Huge impact at triage – Ramping – WR management
- 11. Predictors of Bad Outcomes! • Physiological abnormalities • Failure to recognise & treat • Age >65
- 13. Making Decisions @ Triage Interpret ∨ Discriminate ∨ Evaluate
- 14. Assessment @ Triage Its all about: • Airway • Breathing • Circulation • Disability • Exposure/Environment
- 15. The Approach
- 16. Airway Always check patency – Consider C-Spine precautions • Occluded or compromised airway = ATS 1
- 17. The C-Spine Nexus MOI with 1 Criteria: • Cervical tenderness • Signs of intoxication • Altered Mental state • Significant distracting injury • Focal neurological deficits Canadian • Only use when GCS 15
- 18. Breathing Assessment includes: – Resp Rate – Work of Breathing • Detecting hypoxia is paramount!
- 19. Circulation Assessment includes: – Heart rate – Pulse & pulse characteristics – Cap refill • Signs of haemodynamic compromise = ATS 1 or 2
- 20. Disability Assessment includes: – Use AVPU or GCS • Signs of altered level of consciousness = Important indicator of serious injury/illness
- 21. Environment Assessment Includes: – Assess Temperature • Hypo/hyperthermia are important indicators of serious illness!
- 22. PAIN
- 23. “The eye’s don’t see what the mind doesn’t know!”
- 24. General Appearance Look for: – Observe mobility – Does the patient look sick? – Behaviour – Ability to use vending machine
- 25. The Eyes
- 27. “Trust your instincts not the paramedics!”
- 28. Extremes of Age • Be aware: • Physiological differences, limited reserves
- 29. High Risk Features • Chronic Illness • Cognitive impairment • Co-morbidities • Poisonings • Severe pain • Use caution allocate higher ATS
- 30. High Risk Alerts
- 31. Trauma Patients • Look at MOI: – Vehicle rollover – Death in same vehicle – Ejection – Fall from >3 meters • Use trauma criteria = ATS 1 or 2
- 32. The Rashes
- 33. When Multiple Patients Arrive! • Look for compromised A,B,C • Get SJA to triage themselves • Do a mini triage & priorities
- 34. Managing the WR • Use clinical rounding – Reassess and retriage if need – Treat pain – Manage the families
- 35. Patient 1
- 36. Patient 2 • 80 male • Post fall- GCS 15 • On Pradaxa
- 37. Patient 3 • BIBP –intoxicated-homeless • Obstructive & belligerent
- 38. PEARL • “Alcoholics were put here to burn triage nurses”
- 39. Patient 4 • 20 male • Playing with nail gun • Got nailed!
- 40. Patient 5 • 60 Male • COPD • RR30, Sp02 95%, HR 110
- 41. Questions
- 42. 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!
- 43. Thank you
Editor's Notes
- RR greater than 27 biggest indicator of in hospital cardiac arrest
- Gangs, violent individualsUse police and security