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. 1. Triage BasicsBy Kane Guthrie FCENA
  2. 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. 3. Triage Trier= to sort. Triage= establishing priorities of patientcare for urgent treatment while allocatinglimited resources.
  4. 4. Triage Timely response to abnormal clinicalfindings reduce morbidity & mortality. National Triage Scale (1993-1997) Australasian Triage Scale (1997-present)
  5. 5. The ATS An assessment tool allowing for:– Timeliness– Fairness– Consistency– Time to treatment– Performance appraisal
  6. 6. Time-2-Treatment
  7. 7. Physiological Predictors
  8. 8. Looking for the @Risk• Risk Factors for serious injury/illness
  9. 9. Waiting is Bad
  10. 10. Access Block• Hospital wide issue• Burden is with ED• ∧Morbidity & Mortality• Huge impact at triage– Ramping– WR management
  11. 11. Predictors of Bad Outcomes!• Physiological abnormalities• Failure to recognise & treat• Age >65
  12. 12. Know Your Environment
  13. 13. Making Decisions @ TriageInterpret∨Discriminate∨Evaluate
  14. 14. Assessment @ TriageIts all about:• Airway• Breathing• Circulation• Disability• Exposure/Environment
  15. 15. The Approach
  16. 16. AirwayAlways check patency– Consider C-Spine precautions• Occluded or compromised airway=ATS 1
  17. 17. 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
  18. 18. BreathingAssessment includes:– Resp Rate– Work of Breathing• Detecting hypoxia is paramount!
  19. 19. CirculationAssessment includes:– Heart rate– Pulse & pulse characteristics– Cap refill• Signs of haemodynamic compromise=ATS 1 or 2
  20. 20. DisabilityAssessment includes:– Use AVPU or GCS• Signs of altered level of consciousness=Important indicator of serious injury/illness
  21. 21. EnvironmentAssessment Includes:– Assess Temperature• Hypo/hyperthermia are important indicatorsof serious illness!
  22. 22. PAIN
  23. 23. “The eye’s don’t seewhat the minddoesn’t know!”
  24. 24. General AppearanceLook for:– Observe mobility– Does the patient look sick?– Behaviour– Ability to use vending machine
  25. 25. The Eyes
  26. 26. Some Pearls&Pitfalls
  27. 27. “Trust your instincts notthe paramedics!”
  28. 28. Extremes of Age• Be aware:• Physiological differences, limited reserves
  29. 29. High Risk Features• Chronic Illness• Cognitive impairment• Co-morbidities• Poisonings• Severe pain• Use caution allocate higher ATS
  30. 30. High Risk Alerts
  31. 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. 32. The Rashes
  33. 33. When Multiple Patients Arrive!• Look for compromised A,B,C• Get SJA to triage themselves• Do a mini triage & priorities
  34. 34. Managing the WR• Use clinical rounding– Reassess and retriage if need– Treat pain– Manage the families
  35. 35. Patient 1
  36. 36. Patient 2• 80 male• Post fall- GCS 15• On Pradaxa
  37. 37. Patient 3• BIBP –intoxicated-homeless• Obstructive & belligerent
  38. 38. PEARL• “Alcoholics were puthere to burn triagenurses”
  39. 39. Patient 4• 20 male• Playing with nail gun• Got nailed!
  40. 40. Patient 5• 60 Male• COPD• RR30, Sp02 95%, HR 110
  41. 41. Questions
  42. 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. 43. Thank you

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