emergency triage and treatment

1. ETAT
Emergency Triage Assessment &
Treatment

2. ETAT
• Emergency
• Triage
• Assessment and
• Treatment
• Aims to reduce the number of children dying
in the first 24 hours of admission to hospital

3. Course Objectives
At the end of the course you will be able to:
• Triage all sick children when they arrive at a health facility into
the following categories:
– Those with emergency signs
– Those with priority signs
– Those who are non-urgent cases
• Assess a child’s airway and breathing and give emergency
treatment
• Assess the child’s status of circulation and level of
consciousness
• Manage shock, coma and convulsions in a child
• Assess and manage severe dehydration
• Save Lives!

4. Triage and the ABCD concept
Module One

5. Module One -Objectives
• After this module you will be able to:
• Understand the principles of triage and the ABCD
approach
• Triage all sick children when they arrive at a health
facility into the following categories:
– Those with emergency signs
– Those with priority signs
– Those who are non-urgent cases

6. What is Triage?
• Triage is the sorting of patients into priority groups
according to their need and the resources available
• The aim of triage is to identify very sick children
quickly so they may be treated without delay
• Many children die within the first 24 hours of
admission to hospital and many of these deaths are
preventable. Triage aims to reduce these
unnecessary deaths.

7. Triage Categories
• All sick children are rapidly examined on arrival and
sorted into 3 categories:
• EMERGENCY signs – who require immediate
emergency treatment
• PRIORITY signs – who should be given priority in the
queue, rapidly assessed and treated without delay
• NON-URGENT cases – who can wait their turn in the
queue. The majority of children seen will be non-
urgent cases.

8. Triage Process
• How long does it take?
– Not long! Experienced staff can triage in 20 seconds
• When does it happen?
– As soon as the child arrives in hospital
• Where does it take place?
– Anywhere children are first seen – under 5 clinic, emergency room,
ward
– Emergency treatment area should be close by but some treatments
can be started anywhere
• Who should triage?
– All staff involved in care of sick children should be able to triage and
ideally be able to give emergency treatment
– Non-medical staff who may meet children on arrival should also be
trained in basic triage

9. How to triage
• Assess for each group of emergency signs in turn: ABC(3)D
• As soon as an emergency sign is found emergency treatment
must be started
• Do not wait to assess other ‘E’ signs before starting treatment
• Once treatment is given continue to look for other ‘E’ signs
• If no ‘E’ signs are found move on to Priority signs
• If ‘P’ signs are found child must be given priority for full
assessment and treatment
• If no ‘E’ or ‘P’ signs are found child is a non-urgent case and
should be directed to queue

10. Emergency Signs – ABCD
• Triage involves looking for signs of serious
illness or injury
• Emergency signs are sorted in order of priority
as:
• A = Airway
• B = Breathing
• C = Circulation, Coma, Convulsions
• D = Dehydration

11. Airway or Breathing Problems
• To assess for airway or breathing problems you need to know:
– Is the child breathing?
– Is the airway obstructed?
– Is the child blue (centrally cyanosed)?
– Does the child have severe respiratory distress?
• Look, listen and feel for breathing
• Listen for sounds of obstruction (noisy breathing)
• Look for severe chest in drawing, accessory muscle use, very
fast breathing
• Is the child too breathless to talk or feed?

12. !E Sign!
• If any ‘E’ signs of airway or breathing
problems are found child is classed as ‘E’ or P1
and should be taken immediately for
appropriate emergency treatment.

13. Circulation
• To assess for circulation problems you need to
know:
– Does the child have warm hands?
• If yes move on to assess for coma
– If not, is the capillary refill time longer than 3
secs?
– Is the pulse weak and fast?

14. ! E Sign !
• If any ‘E’ signs of circulation problem are
found child is triaged as ‘E’ or P1 and should
be taken immediately for appropriate
emergency treatment

15. Coma and convulsions
• To assess for coma make a rapid assessment of
conscious level:
– A = ALERT
– V = responds to VOICE
– P = responds to PAIN
– U = UNRESPONSIVE
• A child who responds only to pain or is unresponsive
is classed as coma
• Look for repetitive, abnormal movements or
twitching (signs of convulsion)

16. ! E Signs !
• If any ‘E’ signs of coma or convulsions are
found the child is classed as ‘E’ or P1 and
should be taken immediately for appropriate
medical treatment

17. Dehydration
• To assess for severe dehydration you need to
know:
– If the child is lethargic or unconscious
– If the child has sunken eyes
– If the skin pinch goes back slowly

18. ! E Signs !
• If any ‘E’ sign of dehydration is found the child
is classed as ‘E’ or P1 and should be taken
immediately for emergency treatment

19. ABCD Emergency Signs
• If the child has any sign of the ABCD it means
the child has an emergency ‘E’ sign and
emergency treatment should start
immediately
• When ABCD has been completed and there
are no emergency signs, continue to assess
Priority signs

20. Priority Signs
• These children need prompt, but not
emergency, assessment and treatment
• These signs can be remembered with the
symbols:
3 (TPR )MOB

21. Priority signs – 3 (TPR )MOB
• Tiny baby
• Temperature
• Trauma
• Pallor
• Poisoning
• Pain
• Restless
• Respiratory distress
• Referral
• Malnutrition/ marasmus
• Oedema
• Burns

22. Priority signs 3 (TPR)MOB
• Tiny baby – any sick baby under 2 months
– Small babies difficult to assess, more prone to
infection, more likely to deteriorate quickly
• Temperature: child is very hot
– High fever may need prompt treatment and
investigation eg. Paracetamol
• Trauma or other urgent surgical condition
– Includes acute abdomen, fractures, head injury

23. Priority signs 3 (TPR)MOB
• Pallor
– Severe pallor may indicate severe anaemia needing urgent
transfusion
• Poisoning
– Child with history of swallowing drugs or poisons may
deteriorate rapidly and may need specific urgent
treatment
• Pain
– Severe pain requires early full assessment and pain relief

24. Priority Signs – 3 (TPR) MOB
• Restless, lethargy, irritable
– Child who is conscious but cries constantly and will not
settle. May have serious illness such as meningitis
• Respiratory distress
– Moderate respiratory distress (indrawing or difficulty
breathing that is not severe) requires urgent but not
emergency treatment. If in doubt class as ‘E’
• Referral
– Any urgent referral from another hospital or clinic should
be seen as a priority

25. Priority Signs – 3 (TPR)MOB
• Malnutrition/ marasmus
– Severe wasting may indicate severe malnutrition (
marasmus)
• Oedema
– Oedema of both feet may indicate another form of severe
malnutrition, Kwashiorkor
• Burn
– Major burns are very painful and children can deteriorate
rapidly

26. Non-urgent
• Once assessment is complete if no emergency
or priority signs are found the child is classed
‘non-urgent’ and should wait their turn in the
queue
• However if there is any change in the child’s
condition the child will need to be triaged
again and treated appropriately

27. Treatment
• Emergency management
– Treatment must be started as soon as possible
– Ideally should be directed by senior health worker
– Needs good team work
– Needs frequent reassessment of ABCD
• Priority cases
– Can receive some treatments while waiting eg pain relief,
anti-pyretics

28. Triage - Summary
• Triage is the sorting of patients into priority groups according
to their need
• All children should undergo triage.
• The main steps are:
– Look for Emergency signs (ABCD)
– Treat any Emergency signs you find
– Call a senior health worker to see any emergency
– Look for any Priority signs ( 3TPR MOB)
– Place Priority patients at the front of the queue
– Move on to the next patient
• With practice you will be able to triage in less than 1 minute