educative

1. TRIAGE

2. Goals of Triage
 Rapidly identify patients with urgent,
life-threatening conditions
 Assess/determine severity and acuity of
the presenting problem
 Direct patients to appropriate treatment
areas
 Re-evaluate patients awaiting treatment

3. Advantages of Triage
 Streamlines patient flow.
 Reduces risk of further
injury/deterioration.
 Improves communication and public
relations.
 Enhances teamwork.
 Identifies resource requirements.
 Establishes national benchmarks.

4. Triage Acuity Determinants
 Chief complaint.
 Brief triage history.
Injury or illness(signs & symptoms).
 General appearance.
 Vital signs.
 Brief physical appraisal at triage.

5. Triage Role
• To determine severity of illness
or injury for each patient who
enters the Emergency
Department (ED).

6.  Patients should have a triage assessment
within 10 minutes of arrival in the ED.
 Accurate triage is the key to the efficient
operation of an emergency department.
 Effective triage is based on the knowledge,
skills and attitudes of the triage staff.
Triage

7. Triage Process
 Assess and determine the severity or
acuity of the presenting problem.
 Process the patient into a triage level.
 Determine and direct the patient to
appropriate treatment areas.
 Effectively and efficiently assign
appropriate human health resources.

8. Triage Assessment
 Chief complaint.
 Brief triage history
Injury or illness (signs & symptoms)
 General appearance.
 Vital signs.
 Brief physical appraisal at triage.

9. An assessment tool allows
 Timeliness
 Fairness
 Consistency
 Time to treatment
 Performance appraisal

10. 5 Level Triage
 Level 1 Resuscitative
 Level 2 Emergent
 Level 3 Urgent
 Level 4 Less urgent
 Level 5 Non-urgent

11.  Triage is a dynamic process.
 Reassessment & Reassessment .
 A patient’s condition may improve or
deteriorate during the wait for
treatment.

14. Level I: Resuscitative
 Conditions that are threats to LIFE or LIMB
(or imminent risk of deterioration)
requiring aggressive interventions.
 Time to MD: Immediate
 Time to Nurse: Immediate
 Continuous reassessment

15. Level I
 Usual presentations
 Code / arrest.
 Major trauma.
Severe burns--airway compromise .
 Shock states.
 Severe respiratory distress.
Near death asthma (Status asthmatics).
Tension pneumothorax.
 Altered mental state.
 Seizure (Status epileptics).
 Traumatic shock.
 Overdose.
 AAA.
 AMI with complications.
 Congestive heart failure with low BP.
 Major head injury-unconscious.

16.  Conditions that are a potential threat of life,
limb or function, requiring rapid medical
intervention or delegated acts.
 Time to MD: 15 minutes.
 Time to Nurse: immediate.
 Reassessment time: 15 minutes.
Level II Emergent

17. Level II Emergent
 Usual presentation
 Chest Pain Query MI
 Trauma
 Chemical Exposure
 Stroke
 Altered Consciousness
 Acute MI
 Severe Asthma-stridor
 Acute Psychotic Episode with Agitation
 Severe Pain 8 -10
 Reassessment 15 mins

18. Level III Urgent
 Conditions that could potentially progress to a
serious problem requiring emergency intervention.
 May be associated with significant discomfort or
affecting ability to function at work or activities of
daily living.
 Time to MD: <30 minutes.
 Time to Nurse: 30 minutes.
 Reassessment time: 30 minutes

19. Level III Urgent
 Usual presentations:
 Renal colic, billary colic
 GI bleed with normal VS
 Previous seizure—alert
 Dehydration.
 Shunt dysfunction.
 Vital signs outside normal range.
 Pain scale 4 -7 10
 Moderate risk of harm to self or others.
 Inconsolable infant , infant not feeding.
 Behavior change.
Reassessment 30 minutes

20. Level IV: Less Urgent
 Conditions that related to patient age, distress,
or potential for deterioration or complications
would benefit from intervention or reassurance
within (1 –2 hours)
 Time to MD < 60 minutes (1 hr)
 Time to Nurse < 60 minutes (1 hr)
 Reassessment time: 60 minutes (1 hr)

21. Level IV: Less Urgent
 Usual presentation:
 Head injury—alert.
 Earache.
 Abdominal pain.
 UTI sign and symptoms.
 Simple laceration requiring sutures.
 VS normal
 Reassessment 1 hour

22. Level 5: Non Urgent
 Conditions that may be acute but non-urgent as well
as conditions which may be part of a chronic problem
with or without evidence of deterioration.
 The investigation or interventions could be delayed or
even referred to other area of the hospital or health
care system.
 Time to MD: 120 minutes.
 Time to Nurse: 120 minutes.
 Reassessment time: 120 minutes

23. Level 5: Non Urgent
 Usual presentation:
 Strains.
 Sprains.
 Single episode of vomiting.
 Sore throat.
 Script refills.
 Chronic problems with no change.
 Investigation or intervention for these illnesses or
injuries could be delayed or even deferred.
 Reassessment 2 hours 120 minutes

24. Pediatric Triage PCTAS
 There are three things that must be
assessed and documented on all
pediatric patients:
 Respiratory rate.
 Heart rate.
 Capillary refill.

25. Pediatric CTAS
Poster Pocket Card

26. Pediatric Vital Signs
 Must include:
 Heart rate.
 Blood pressure.
 Respiratory rate.
 O2 saturation.
 Temperature.
 Capillary refill.
 Accurate weight!

27.  Vitals Are Your Safety Net.
 Less Urgent and Non Urgent patients
have NORMAL vital signs.
 Abnormal vital signs are at least an
URGENT.

28.  Triage is a dynamic process
 A patients condition may improve or
deteriorate during the waiting for
treatment
 Reassessment, Reassessment,
Reassessment

29. The end
 END

30. Triage Practical

31. Injury Prevention

38. Injury prevention practical

39.  ABCs…IV, O2, monitor
 Decontaminate if organophosphates prior touching by health
care professionals
 Lily kit for cyanide poisoning.
 History
 Obtain all prescription and bottles in the household (call
pharmacy).
 Pill count.
 PM Hx.
 Search clothes for clues, medication alerts, pills etc.
 Contact family members.
 Track marks, consider body packing or stuffing.
 Vital signs, Rhythm strip.
General Approach to
POISONED Patient

40.  What are the essential features of a
30-second toxicological exam?
 Vital signs- HR, RR, BP.
 Temperature- rectal
(resp rate can affect oral temperature).
 Skin- color, temperature, and sweating.
 Odors- provide clues
(their absence means nothing)
 Bowel sounds and bladder function.
 Mental status.
General approach to poisoned pt.

41. General approach to poisoned pt
 Tests
 GI Decontamination
 Activated Charcoal
 Antidotes

42. Practical