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The Emergency Triage
Anusorn Karaker .
Registered nurse (RN),MNS.
Rasisalai Hospital , Thailand
Free PowerPoint Templates
Triage
• “triage” มาจากภาษาฝรั่งเศสที่ว่า“trier”
แปลว่า to “sort” or “choose”.
• ระบบในการจาแนกผู้ป่ วยตามลาดับความรุนแรงข...
Triage
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ในสมัยนั้นการจาแนกได้กระทาโดยการ “เดา” เป็นหลัก และเน้นคัดกรองเพื่อให้ได้รับ
การรักษาอย่า...
Patient Classification
Free PowerPoint Templates
Johnson, 1984 : เป็ นระบบการจัดผู้ป่ วยให้เป็ นระดับชั้น และกลุ่มต่างๆ ตา...
Patient Classification
Free PowerPoint Templates
"Who should be seen first ? "
"How long can each patient safely wait ?"
G...
Patient Classification
Free PowerPoint Templates
The American Hospital Association
Emergency Severity Index (ESI)
The American Hospital Association
Free PowerPoint Templates
Emergency Urgent Nonurgent
The 3-level acuity-rating scale
•em...
Emergency Severity Index (ESI)
A Triage Tool for Emergency
Department Care version 4
Free PowerPoint Templates
5 ระดับ
• ร...
Emergency Severity Index (ESI)
A Triage Tool for Emergency
Department Care version 4
Free PowerPoint Templates
Resuscitati...
the Emergency Severity Index
Free PowerPoint Templates
Research on the Emergency
Severity Index
•improvements in ED operations
•support for research and surveillance
•for benchm...
The purpose of ED triage
• to prioritize incoming patients and to identify those patients
who cannot wait to be seen
• to ...
Free PowerPoint Templates
• ESI (USA)
• Canadian Triage and Acuity Scale (CTAS)
• Australasian Triage Scale (ATS)
• Manche...
Free PowerPoint Templates
Emergency
Severity Index
Free PowerPoint Templates
Emergency
Severity Index
Free PowerPoint Templates
Emergency
Severity Index
Free PowerPoint Templates
Emergency
Severity Index Is This a High-Risk Situation?
Free PowerPoint Templates
Emergency
Severity Index
START TRIAGE
30 - 2 -Can do
R-P-M
R = Respiration > 30 ครั้ง/นาที.........
Free PowerPoint Templates
Emergency
Severity Index
A. dying?
B. shouldn't wait?
C. many resources?
D. vital signs?
Free PowerPoint Templates
NANDA Nursing
Diagnoses
NOC Outcomes and Indicators NIC Intervention Label and
select nursing ac...
Free PowerPoint Templates
Free PowerPoint Templates
Gilboy N, Tanabe T, Travers D, Rosenau AM. Emergency Severity Index (ESI): A Triage
Tool for Eme...
Free PowerPoint Templates
European Resuscitation Council
Guidelines for Resuscitation 2015
Section 1. Executive summary
BC...
Free PowerPoint Templates
Free PowerPoint Templates
1669
Free PowerPoint Templates
The chain of survival
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1: Early recognition and call for help
2: Early bystander CPR
3: Early defibrillation
4: Early ad...
Free PowerPoint Templates
1: Early recognition and call for help
The chain of survival
Recognising the cardiac origin of c...
Free PowerPoint Templates
2: Early bystander CPR
The chain of survival
 The immediate initiation of CPR can double or
qua...
Free PowerPoint Templates
3: Early defibrillation
The chain of survival
 Defibrillation within 3–5 min of collapse can prod...
Free PowerPoint Templates
4: Early advanced life support and
standardised post-resuscitation care
The chain of survival
 ...
Free PowerPoint Templates
Adult BLS sequence
Free PowerPoint Templates
Look , listen and feel
for Normal breathing
Alert emergency Service
Send someone to get AED.
Adu...
Free PowerPoint Templates
Adult BLS sequence
Make sure you, the victim and any
bystanders are self
Check the Victim for a ...
Free PowerPoint Templates
Start Chest Compression
Adult BLS sequence
Free PowerPoint Templates
Combine chest compression with recue breaths
If Untrained or Unable to do Rescue Breaths
Continu...
Free PowerPoint Templates
Switch on the AED and
attach the electrode pad
Follow the spoken/visual
directions
If Shock is i...
Free PowerPoint Templates
Continue
CPR
If unresponsive but breathing normally
If you are certain the victim is breathing
n...
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Foreign body airway obstruction (choking)
Suspect Choking
Be alert to choking particularly if vi...
Free PowerPoint Templates
Foreign body airway obstruction (choking)
Give Back Blows
If cough becomes ineffective give up t...
Free PowerPoint Templates
In Hospital Resuscitation
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ACLS
Free PowerPoint Templates
ACLS etc.
Free PowerPoint Templates
Quality During CPR and Treat Reversible Causes
Free PowerPoint Templates
Free PowerPoint Templates
Drowning chain of survival
Free PowerPoint Templates
Free PowerPoint Templates
Thank for attention
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Emergency Triage and BCLS ,ACLS 2015

Emergency Triage and ACLS 2015

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Emergency Triage and BCLS ,ACLS 2015

  1. 1. The Emergency Triage Anusorn Karaker . Registered nurse (RN),MNS. Rasisalai Hospital , Thailand Free PowerPoint Templates
  2. 2. Triage • “triage” มาจากภาษาฝรั่งเศสที่ว่า“trier” แปลว่า to “sort” or “choose”. • ระบบในการจาแนกผู้ป่ วยตามลาดับความรุนแรงของโรค • ซึ่งได้มีการริเริ่มมาตั้งแต่สมัยสงครามโลกครั้งที่ 1 • โดยนายแพทย์ชาวฝรั่งเศสชื่อ Dominique Jean Larrey Free PowerPoint Templates
  3. 3. Triage Free PowerPoint Templates ในสมัยนั้นการจาแนกได้กระทาโดยการ “เดา” เป็นหลัก และเน้นคัดกรองเพื่อให้ได้รับ การรักษาอย่างรวดเร็วมากกว่าความแม่นยา
  4. 4. Patient Classification Free PowerPoint Templates Johnson, 1984 : เป็ นระบบการจัดผู้ป่ วยให้เป็ นระดับชั้น และกลุ่มต่างๆ ตามลักษณะความเจ็บป่ วย โดยมีวัตถุประสงค์เพื่อใช้เป็ นเครื่องมือจัดทาระบบปฏิบัติการพยาบาลให้เป็ นมาตรฐาน โดยเฉพาะ อย่างยิ่งในการประมาณการอัตรากาลังบุคลากรทางการพยาบาล Gillies, 1994 : เป็ นการจัดกลุ่มผู้ป่ วยตามปริมาณและความซับซ้อนของความต้องการในการพยาบาล Fagerstrom, Eriksson, & Engberg, 1999 : เป็ นการประเมินความต้องการในการดูแลเฉพาะบุคคลตาม ช่วงเวลา ซึ่งจะแบ่งตามความต้องการในการดูแลและกิจกรรมการพยาบาล Faggestrom, Rainio, Rauhala, & Nojonen, 2000 : เป็ นการจัดกลุ่มโดยอาศัยการประมาณ ความต้องการการดูแลในช่วงเวลาใดเวลาหนึ่ง ตามการรับรู้ความต้องการการดูแลผู้ป่ วย ความ รุนแรงของความเจ็บป่ วย สานักการพยาบาล กระทรวงสาธารณสุข (2547) : เป็ นการจัดกลุ่มผู้ป่ วยในความดูแลของพยาบาลในช่วงเวลา ใดเวลาหนึ่ง โดยวัตถุประสงค์เพื่อการวางแผนการดูแล คานวณและวางแผนอัตรากาลังและคานวณค่าใช้จ่าย ของผู้ป่ วยแต่ละกลุ่ม และหรือหน่วยงาน/องค์กร
  5. 5. Patient Classification Free PowerPoint Templates "Who should be seen first ? " "How long can each patient safely wait ?" Gilboy, Travers, & Wuerz, 1999; Wuerz, Milne, Eitel, Travers, & Gilboy, 2000
  6. 6. Patient Classification Free PowerPoint Templates The American Hospital Association Emergency Severity Index (ESI)
  7. 7. The American Hospital Association Free PowerPoint Templates Emergency Urgent Nonurgent The 3-level acuity-rating scale •emergent, urgent, and nonurgent •unclear, not uniform and are often hospital dependent and nurse dependent
  8. 8. Emergency Severity Index (ESI) A Triage Tool for Emergency Department Care version 4 Free PowerPoint Templates 5 ระดับ • ระดับ1 (most urgent) - ระดับ5 (least urgent) • แบ่งตามacuity และ resource needs •ESI concept in 1998
  9. 9. Emergency Severity Index (ESI) A Triage Tool for Emergency Department Care version 4 Free PowerPoint Templates Resuscitation Emergent Urgent Less- Urgent Non- Urgent ผู้ป่ วยวิกฤติ เจ็บป่ วย รุนแรง เจ็บป่ วยปาน กลาง เจ็บป่ วย เล็กน้อย เจ็บป่ วย ทั่วไป
  10. 10. the Emergency Severity Index Free PowerPoint Templates
  11. 11. Research on the Emergency Severity Index •improvements in ED operations •support for research and surveillance •for benchmarking (Wuerz et al., 2000. ; Travers, Waller, Bowling, Flowers, &Tintinalli, 2002.; Eitel,Travers, Rosenau, Gilboy, & Wuerz, 2003 ; Tanabe, Gimbel, Yarnold, Kyriacou, & Adams, 2004 ; Worster et al., 2004 ; Durani, Breecher, Walmsley, Attia, & Loiselle, 2009) Free PowerPoint Templates
  12. 12. The purpose of ED triage • to prioritize incoming patients and to identify those patients who cannot wait to be seen • to cope with overcrowding there is a critical need for a valid, reliable triage acuity rating system in order to sort these incoming patients more rapidly and accurately Free PowerPoint Templates
  13. 13. Free PowerPoint Templates • ESI (USA) • Canadian Triage and Acuity Scale (CTAS) • Australasian Triage Scale (ATS) • Manchester Triage Scale (U.K.)
  14. 14. Free PowerPoint Templates Emergency Severity Index
  15. 15. Free PowerPoint Templates Emergency Severity Index
  16. 16. Free PowerPoint Templates Emergency Severity Index
  17. 17. Free PowerPoint Templates Emergency Severity Index Is This a High-Risk Situation?
  18. 18. Free PowerPoint Templates Emergency Severity Index START TRIAGE 30 - 2 -Can do R-P-M R = Respiration > 30 ครั้ง/นาที..........เป็ นสีแดง P = Perfusion > 2 วินาที.................จัดเป็ นสีแดง M = Mental status = ทาตามสั่งได้ ( Can do) จัดเป็ นสีเหลือง
  19. 19. Free PowerPoint Templates Emergency Severity Index A. dying? B. shouldn't wait? C. many resources? D. vital signs?
  20. 20. Free PowerPoint Templates NANDA Nursing Diagnoses NOC Outcomes and Indicators NIC Intervention Label and select nursing activities Risk for infection related to immunosuppression secondary to chemotherapy, inadequate primary defenses (central venous catheter), chronic disease (ALL) and developmental level. 0702Immune Status Definition: Natural and acquired appropriately targeted resistance to internal and external antigens. 1=severely compromised thru 5= not compromised Absolute WBC values WNL(within normal limits) 1 2 3 4 5 Differential WBC values WNL(within normal limits) 1 2 3 4 5 Skin integrity 1 2 3 4 5 Mucosa integrity 1 2 3 4 5 Body temperature IER( in expected range) 1 2 3 4 5 Gastrointestinal function 1 2 3 4 5 1 2 3 4 5 (NOC, 2008 p.399) 6550 infection protection Definition: Prevention and early detection of infection in a patient at risk Activities: Monitor for systemic and localized signs & symptoms of infection (central line site check every 4 hours.) Monitor WBC, and differential results (qod) Follow neutropenic precautions Provide a private room Limit number of visitors Screen all visitors for communicable disease Maintain asepsis Inspect skin and mucous membranes for redness, extreme warmth or drainage (q4 hours) Inspect condition of surgical incision (central line insertion site q 4 hours) Obtain cultures, as needed (Blood cultures prn T>38.3 C q 24 hours) (Drainage @ Central line site) Promote Nutritional intake (1500 kcal per day, Pt likes cereal) Encourage fluid intake (1225 cc per day, Pt likes orange Gatorade) Encourage rest (naps daily 1-3 PM, bedtime t 8:30 PM) Monitor for change in energy level/malaise Instruct patient to take anti-infective as prescribed (Bactrim po BID; Nystatin 5cc,swish & swallow, TID) Teach Family about s & symptoms of infection and when to report them to HCP -Teach patient and family how to avoid infections (NIC, 2008)
  21. 21. Free PowerPoint Templates
  22. 22. Free PowerPoint Templates Gilboy N, Tanabe T, Travers D, Rosenau AM. Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care, Version 4. Implementation Handbook 2012 Edition. AHRQ Publication No.12-0014. Rockville, MD. Agency for Healthcare Research and Quality. November 2011
  23. 23. Free PowerPoint Templates European Resuscitation Council Guidelines for Resuscitation 2015 Section 1. Executive summary BCLS & ACLS
  24. 24. Free PowerPoint Templates
  25. 25. Free PowerPoint Templates 1669
  26. 26. Free PowerPoint Templates The chain of survival
  27. 27. Free PowerPoint Templates 1: Early recognition and call for help 2: Early bystander CPR 3: Early defibrillation 4: Early advanced life support and standardised post-resuscitation care The chain of survival
  28. 28. Free PowerPoint Templates 1: Early recognition and call for help The chain of survival Recognising the cardiac origin of chest pain, and calling the emergency services before a victim collapses, enables the emer- gency medical service to arrive sooner, hopefully before cardiacarrest has occurred, thus leading to better survival
  29. 29. Free PowerPoint Templates 2: Early bystander CPR The chain of survival  The immediate initiation of CPR can double or quadruple survival after cardiac arrest.  If able, bystanders with CPR training should give chest compressions together with ventilations.  CPR while awaiting the arrival of professional help.
  30. 30. Free PowerPoint Templates 3: Early defibrillation The chain of survival  Defibrillation within 3–5 min of collapse can produce survival rates as high as 50–70%. This can be achieved by public access and onsite AEDs.
  31. 31. Free PowerPoint Templates 4: Early advanced life support and standardised post-resuscitation care The chain of survival  Advanced life support with airway management, drugs and correcting causal factors may be needed if initial attempts at resuscitation are un-successful.
  32. 32. Free PowerPoint Templates Adult BLS sequence
  33. 33. Free PowerPoint Templates Look , listen and feel for Normal breathing Alert emergency Service Send someone to get AED. Adult BLS sequence
  34. 34. Free PowerPoint Templates Adult BLS sequence Make sure you, the victim and any bystanders are self Check the Victim for a response Open the Airway
  35. 35. Free PowerPoint Templates Start Chest Compression Adult BLS sequence
  36. 36. Free PowerPoint Templates Combine chest compression with recue breaths If Untrained or Unable to do Rescue Breaths Continue compression only CPR Adult BLS sequence
  37. 37. Free PowerPoint Templates Switch on the AED and attach the electrode pad Follow the spoken/visual directions If Shock is indicated deliver Shock If no shock is indicated continue CPR Adult BLS sequence
  38. 38. Free PowerPoint Templates Continue CPR If unresponsive but breathing normally If you are certain the victim is breathing normally but still Unresponsive , Place in the recovery position Adult BLS sequence
  39. 39. Free PowerPoint Templates Foreign body airway obstruction (choking) Suspect Choking Be alert to choking particularly if victim is eating Encourage to cough Instruct victim to cough
  40. 40. Free PowerPoint Templates Foreign body airway obstruction (choking) Give Back Blows If cough becomes ineffective give up to 5 bag bows Give abdominal thrusts If back blows are ineffective give up to 5 abdominal thrusts
  41. 41. Free PowerPoint Templates In Hospital Resuscitation
  42. 42. Free PowerPoint Templates ACLS
  43. 43. Free PowerPoint Templates ACLS etc.
  44. 44. Free PowerPoint Templates Quality During CPR and Treat Reversible Causes
  45. 45. Free PowerPoint Templates
  46. 46. Free PowerPoint Templates Drowning chain of survival
  47. 47. Free PowerPoint Templates
  48. 48. Free PowerPoint Templates Thank for attention

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