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5.
ER triage <ul><li>Who performs the ER triage? </li></ul><ul><li>“ Physician or other qualified medical personnel” </li></ul><ul><li>( EMTALA ) </li></ul><ul><li>Nurse triage? </li></ul><ul><li>But physicians must be responsible for all triage examination performed by physician assistants, nurses or housestaffs. </li></ul>
20.
การประยุกต์ความรู้เพื่อใช้ในการจัดลำดับความเร่งด่วนของผู้ป่วย <ul><li>Remember !! Emergency room triage ≠ Telephone triage </li></ul><ul><li>The patient is in front of you and you have a lot of equipments to help you find out these conditions (BP, Pulse oximetry) at ER triage </li></ul><ul><li>For telephone triage, you have to find these </li></ul><ul><li>condition only by short, simple conversation </li></ul><ul><li>You may have to give instructions to the bystander(s) for life-saving procedures. </li></ul>
21.
การประยุกต์ความรู้เพื่อใช้ในการจัดลำดับความเร่งด่วนของผู้ป่วย <ul><li>Must need proper and authorized medical command (direct/indirect) </li></ul>
28.
รูปแบบการตอบสนอง <ul><li>รหัสแดง </li></ul><ul><li>First responder (BLS) 4 min ALS 8 min </li></ul><ul><li>รหัสเหลือง </li></ul><ul><li>First responder (BLS) 8 min ALS 15 min </li></ul><ul><li>รหัสเขียว </li></ul><ul><li>Only first responder (BLS) </li></ul><ul><li>รหัสขาว </li></ul><ul><li>ส่งต่อทางโทรศัพท์เท่านั้น (Telephone referral program) </li></ul><ul><li>รหัสดำ </li></ul><ul><li>No emergency patient </li></ul>
34.
Pre-arrival telephone tele-instruction <ul><li>Respiratory arrest and Cardiac arrest </li></ul><ul><li>Adult choking </li></ul><ul><li>Loss of consciousness </li></ul><ul><li>Truly BLS </li></ul><ul><li>Do not delay the initial dispatch response!! </li></ul>
35.
Pre-arrival telephone tele-instruction : Respiratory arrest <ul><li>ไม่หายใจแต่ยังมีการไหลเวียนโลหิต </li></ul><ul><li>Primary respiratory arrest lead in cardiopulmonary arrest in 5 minutes </li></ul>
36.
Respiratory arrest <ul><li>สาเหตุ : Foreign body </li></ul><ul><li>Drowning </li></ul><ul><li>Poison </li></ul><ul><li>Inhalation </li></ul><ul><li>Electrical injury </li></ul><ul><li>Coma from any cause </li></ul>
37.
Pre-arrival telephone tele-instruction : Respiratory arrest <ul><li>Airway control </li></ul><ul><li>Ventilation support </li></ul>
41.
Pre-arrival telephone tele-instruction : Adult choking <ul><li>Able to talk/cough => stop </li></ul><ul><li>Unable to talk/cough, Conscious </li></ul><ul><li>“ Heimlich maneuver” </li></ul><ul><li>If became unconscious </li></ul><ul><li>Is patient moving/breathing? </li></ul><ul><li>Yes => roll the person on his side, check breathing until help takes over </li></ul><ul><li>No => head tilt/chin lift, give 2 breathes </li></ul>
42.
Pre-arrival telephone tele-instruction : Adult choking <ul><li>Chest rise ? </li></ul><ul><li>yes => not moving/breathing => CPR </li></ul><ul><li>no => abdominal thrusts 5 times </li></ul><ul><li>If you see something, turn the head to side and try to sweep it out, do not push it backwards </li></ul>
43.
Pre-arrival telephone tele-instruction : Unconscious, breathing normally <ul><ul><li>Airway control </li></ul></ul><ul><ul><li>Look, listen and feel for air movement </li></ul></ul><ul><ul><li>Vomiting </li></ul></ul><ul><ul><li>Turn his head to the side </li></ul></ul><ul><ul><li>Sweep it with your fingers </li></ul></ul><ul><ul><li>Is the person breathing normally? </li></ul></ul><ul><ul><li>Yes => continue watching </li></ul></ul><ul><ul><li>No => Go to choking (start from head tilt/chin lift) </li></ul></ul>