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Triage basics
The document outlines the fundamentals of triage, including its definition, the Australian and Australasian Triage Scales, and the assessment of patients based on physiological predictors and risk factors for poor outcomes. It emphasizes the importance of timely response to clinical findings and provides guidelines for evaluating airway, breathing, circulation, and disability during triage. Additionally, it highlights critical observations and alerts for high-risk patients, as well as strategies for managing crowded waiting rooms.
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Triage basics
- 1. Triage Basics By KaneGuthrie FCENA
- 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. Triage Trier= tosort. Triage= establishing priorities of patient care for urgent treatment while allocating limited resources.
- 4. Triage Timely responseto abnormal clinical findings reduce morbidity & mortality. National Triage Scale (1993-1997) Australasian Triage Scale (1997-present)
- 5. The ATS Anassessment tool allowing for: – Timeliness – Fairness – Consistency – Time to treatment – Performance appraisal
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- 8. Looking for the@Risk • Risk Factors for serious injury/illness
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- 10. Access Block • Hospitalwide issue • Burden is with ED • ∧Morbidity & Mortality • Huge impact at triage – Ramping – WR management
- 11. Predictors of BadOutcomes! • Physiological abnormalities • Failure to recognise & treat • Age >65
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- 13. Making Decisions @Triage Interpret ∨ Discriminate ∨ Evaluate
- 14. Assessment @ Triage Itsall about: • Airway • Breathing • Circulation • Disability • Exposure/Environment
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- 16. Airway Always check patency –Consider C-Spine precautions • Occluded or compromised airway = ATS 1
- 17. The C-Spine Nexus MOI with1 Criteria: • Cervical tenderness • Signs of intoxication • Altered Mental state • Significant distracting injury • Focal neurological deficits Canadian • Only use when GCS 15
- 18. Breathing Assessment includes: – RespRate – Work of Breathing • Detecting hypoxia is paramount!
- 19. Circulation Assessment includes: – Heartrate – Pulse & pulse characteristics – Cap refill • Signs of haemodynamic compromise = ATS 1 or 2
- 20. Disability Assessment includes: – UseAVPU or GCS • Signs of altered level of consciousness = Important indicator of serious injury/illness
- 21. Environment Assessment Includes: – AssessTemperature • Hypo/hyperthermia are important indicators of serious illness!
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- 23. “The eye’s don’tsee what the mind doesn’t know!”
- 24. General Appearance Look for: –Observe mobility – Does the patient look sick? – Behaviour – Ability to use vending machine
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- 27. “Trust your instinctsnot the paramedics!”
- 28. Extremes of Age •Be aware: • Physiological differences, limited reserves
- 29. High Risk Features •Chronic Illness • Cognitive impairment • Co-morbidities • Poisonings • Severe pain • Use caution allocate higher ATS
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- 31. Trauma Patients • Lookat MOI: – Vehicle rollover – Death in same vehicle – Ejection – Fall from >3 meters • Use trauma criteria = ATS 1 or 2
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- 33. When Multiple PatientsArrive! • Look for compromised A,B,C • Get SJA to triage themselves • Do a mini triage & priorities
- 34. Managing the WR •Use clinical rounding – Reassess and retriage if need – Treat pain – Manage the families
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- 36. Patient 2 • 80male • Post fall- GCS 15 • On Pradaxa
- 37. Patient 3 • BIBP–intoxicated-homeless • Obstructive & belligerent
- 38. PEARL • “Alcoholics wereput here to burn triage nurses”
- 39. Patient 4 • 20male • Playing with nail gun • Got nailed!
- 40. Patient 5 • 60Male • COPD • RR30, Sp02 95%, HR 110
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- 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!
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