14

Triage Emergency

Emergency rooms use various triage systems, but all share this characteristic of a hierarchy based on the potential for loss of life. A basic and widely used system uses three categories: emergent, urgent, and non-urgent.

Emergent patients have the highest priority—their conditions are life threatening, and they must be seen immediately. Urgent patients have serious health problems, but not immediately life threatening ones; they must be seen within 1 hour. Non-urgent patients have episodic illnesses that can be addressed within 24 hours without increased morbidity.

A fourth, increasingly used class is “fast-track.” These patients require simple

first aid or basic primary care. They may be treated in the ED

or safely referred to a clinic or physician’s office.

For the patient with an emergent or urgent health problem, stabilization,

provision of critical treatments, and prompt transfer to the appropriate setting (intensive care unit, operating room, general care unit) are the priorities of emergency care. Although treatment is initiated in the emergency department.

Emergency Priority

always check the following in this order: Mental status (conscious or unconscious), Airway (is it open), Breathing (is the victim breathing and is it adequate - Begin rescue breathing or give two breaths and start CPR), then Circulation (check for severe bleeding and stop it and check for pulse and start CPR if no pulse). These are the IMMEDIATE LIFE THREATS.

Next, you would check for the POTENTIAL LIFE THREATS. This is a rapid head-to-toe check looking for serious injuries, broken bones, signs of internal bleeding, etc. In addition, if the victim is able to talk or if there is family around that can give info, ask them about signs and symptoms they are having, allergies to medications or foods, medications they are taking, past medical history, last time they had something to eat or drink, and what they were doing right before they were injured or became ill. The reason for taking the time to do this is because a lot of times the person may become unconscious before the ambulance arrives and now they and the hospital are having to start from scratch trying to figure out what is going on. It goes a LONG way to improving proper care and treatment.

Field assessments are made by two methods: primary survey (used to detect & treat life-threatening injuries) and secondary survey (used to treat non-life threatening injuries) with the following categories: ( in USA )

§  Class I Patients who require minor treatment and can return to duty in a short period of time.

§  Class II Patients whose injuries require immediate life sustaining measures.

§  Class III Patients for whom definitive treatment can be delayed without loss of life or limb.

§  Class IV Patients requiring such extensive care beyond medical personnel capability and time.

Emergency department triage categories

Triage category 1: need for resuscitation - patients seen immediately. People in this group are critically ill and require immediate attention. Most arrive at the emergency department by ambulance. This group includes people whose heart may have stopped beating, whose blood pressure may have dropped to dangerously low levels, who may be barely breathing or have stopped breathing, who may have suffered a critical injury or who may have had an overdose of intravenous drugs and be unresponsive.

Triage category 2 : emergency - patients seen within 10 minutes. People in this group will probably be suffering a critical illness or very severe pain. For example, the group includes people with serious chest pain likely to be related to a heart attack, people with difficulty breathing and people with severe fractures.

Triage category 3 : urgent - patients seen within 30 minutes. People in this group include patients suffering from severe illnesses, people with head injuries but who are conscious, and people with major bleeding from cuts, major fractures, persistent vomiting or dehydration.

Triage category 4 : semi-urgent - patients seen within 60 minutes. People in this group usually have less severe symptoms or injuries, although the condition may be potentially serious. Examples include people with mild bleeding, a foreign body in the eye, a head injury (but where the patient never lost consciousness), a sprained ankle, possible bone fractures, abdominal pain, migraine or earache.

Triage category 5 : non-urgent - patients seen within 120 minutes. People in this group usually have minor illnesses or symptoms that may have been present for more than a week, like rashes or minor aches and pains. The group includes people with stable chronic conditions who are experiencing minor symptoms.

Assess and intervene:

The emergency department staff work collaboratively and follow the ABCD

(airway, breathing, circulation, disability) method:

• Establish a patent airway.

• Provide adequate ventilation, employing resuscitation measures when necessary. (Trauma patients must have the cervical

spine protected and chest injuries assessed first.)

• Evaluate and restore cardiac output by controlling hemorrhage, preventing and treating shock, and maintaining or

restoring effective circulation.

• Determine neurologic disability by assessing neurologic

function using the Glasgow Coma Scale .

***After these priorities have been addressed, the  emergency department team proceeds with the secondary survey. This includes

• A complete health history and head-to-toe assessment

• Diagnostic and laboratory testing

• Insertion or application of monitoring devices such as electrocardiogram

(ECG) electrodes, arterial lines, or urinary

catheters

• Splinting of suspected fractures

• Cleaning and dressing of wounds

• Performance of other necessary interventions based on the

individual patient’s condition

Examples on emergent critical:

1. Airway obstruction :

Acute upper airway obstruction is a life-threatening medical emergency. The airway may be partially or completely occluded.

If the airway is completely obstructed, permanent brain damage or death will occur within 3 to 5 minutes secondary to hypoxia.

Partial obstruction of the airway can lead to progressive hypoxia, hypercarbia, and respiratory and cardiac arrest.

Upper airway obstruction has a number of causes, including aspiration of foreign bodies, anaphylaxis, viral or bacterial infection, trauma, and inhalation or chemical burns. In adults, aspiration of a bolus of meat is the most common cause of airway obstruction.

In children, small toys, buttons, coins, and other objects are commonly aspirated in addition to food. Peritonsillar abscesses, epiglottitis, and other acute infectious processes of the posterior pharynx can result in airway obstruction.

2. Near-drowning

3. anaphylactic reaction

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4. Other problems difficult berthing 

5. 
   

6. Cardiac arrest (caused by HF, RF, RTA …ect)

7. 
   

*** Examples on Urgent critical:

1. Chest pain

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2. Severe fractures

      3. Difficult of berthing

     

    

*** Examples on Semi - urgent critical:

1. Foreign body in the eye

2. Abdominal pain

3. Head injury (but where the patient never lost consciousness)

4. Migraine or earache

*** Examples on Non - urgent critical:

1. Skin rashes  or minor aches

1. 
   
2. Chronic diseases with simple symptoms .