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Triage Basics and Paediatric Triage

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by

Gabby McCormack

on 12 February 2013

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Transcript of Triage Basics and Paediatric Triage

Paediatric Triage Triage Basics and Triage Basics Triage Triage decisions should be made in response to the patient's presenting signs and symptoms. No attempt should be made to formulate a diagnosis.

For example: Croup, Seizure, Asthma Triage Decisions should be based upon objective and subjective data Primary Survey The structured approach Primary survey AIRWAY...... Primary Survey Triage decisions are complex clinical decisions

They are often made under conditions of uncertainty with limited or unclear information,
minimal time and with little margin for error. Important key issues with Triage: Decipher the useful information from all the
information provided by the parent/caregiver in order to perform triage safely. rapidly identify and respond to actual life threatening states. rapidly identify the potential for life threatening states to occur. The allocation of a triage category is made on the basis of: necessity for time-critical intervention, potential threat to life or need to relieve suffering. Objective data Primary Survey Physiological data Subjective Data Chief complaint
Precipitating event/onset of symptoms
Mechanism of injury
Relevant past history Should be a structured approach:

Airway
Breathing
Circulation
Disability begins with the patient's "general appearance"
This is an essential component of a triage assessment. patients appearance
patient's behaviour Does the patient look sick?? Check the airway for patency and consider cervical spine precautions. an occluded airway or an immediate risk to airway must be allocated ATS category 1 Stridor is an indicator of airway obstruction in infants and young children. Evaluation of the extent of the airway obstruction should be made by assessing the work of breathing and the degree of respiratory distress. BREATHING...... Assessment of breathing includes determination of:
respiratory rate and work of breathing.

Work of breathing and mental status are very useful indicators of severity of respiratory distress.


Patient's with evidence of respiratory dysfunction during the triage assessment warrant allocation to a high triage category.

ATS category 4 and 5 should demonstrate no respiratory distress.

Signs of work of breathing or respiratory distress Primary Survey CIRCULATION......... Assessment of circulation includes determining heart rate, pulse and pulse characteristics, skin indicators - colour and capillary refill, oral intake and output. Bradycardia - is preterminal
Hypotension also preterminal but never measured at triage Normal physiological parameters are different in children dependant upon age and so the triage nurse needs to be able to identify normal values for children Circulation ?????? How can we Assess this at Triage?? Airway?? How do we assesss
this at Triage??? Breathing ??? How can we assess this at triage??? Disability????? How do we assess this at triage???? Primary Survey DISABILITY...... AVPU
GCS
Level of activity Altered level of consciousness is an important indicator of risk for serious illness or injury + pain
+ neurovascular obs Subjective Data collection Triage nurse is usually the first person the child and family meet in the Emergency Department. Examples of subjective data collected during triage assessment: Chief complaint
Precipitating event/onset of symptoms
Mechanism of injury
Risk factors for serious illness or injury
Relevant past history DOCUMENTATION: The Australasian College of Emergency Medicine (ACEM) states that documentation of the triage assessment should include at least the following: Date &time of assessment
Name of the triage nurse
Chief complaint/presenting problem
Limited relevant findings
Relevant assessment findings
Triage category
allocated area
First aid or treatment initiated at triage "If it is not documented then it was not done" Summary....... Maintain patient and your safety.
Always ask the question "Does this person look sick?"
The primary survey approach should be used to identify actual or potential life threatening conditions at triage
Use the ATS and the paediatric physiological descriminators in order to guide your triage decision making
Never leave the triage desk unattended
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