Triage mania
"I was taking my contacts out last night, and I think I scratched my cornea". The light hurts my eyes. Right eye is red and tearing. She rates her pain 6/10. Vitals are within normal limits.
What is ESI level 5. Patient will need an eye exam, send home with prescriptions and a follow up with ophthalmologist.
"I only went inside for 30 seconds!" Cries the mother of a 2 year old male, who was pulled from the family swimming pool unresponsive by a neighbor, who immediately applied CPR and resuscitated the child. He is now breathing on his own, but still unresponsive. HR 126, RR 28, BP 80/64, SpO2 96% on a NRB mask.
What is ESI Triage level 1, unresponsive. The baby cannot protect his own airway and will require immediate life saving interventions to address airway, breathing, circulation.
Out of the four patients in the waiting room, (leg pain, COPD exacerbation, chest pain, angioedema) this one gets my last remaining bed in the ED.
What is the patient with Angioedema, this can cause someone to lose their airway and become life threatening. Chest pain closely following, COPD and leg pain.
What is behavioral health triage.
We do this to improve patient safety, outcomes, traffic control in the ED and identify acuity.
What is systematic ESI/Triage
EMS presents with an 18 year old female with suspected medication overdose. Roommates found her lethargic and not acting right, so they called 911. Patient does have history of depression. She has multiple superficial lacerations to both wrists. RR 10, SpO2 82% RA.
What is ESI Level 1, pt needs immediate intubation to protect her airway.
Mechanism for injury is one of the considerations for this patient.
What is a high risk patient.
On the ESI triage index, these are considered to be resources. (Think of at least 3)
What are labs, imaging, IV fluids, IV/IM or neb medications, specialty consults, simple procedure ex. lac repair.
We take it seriously when we have a patient who reports suicidal ideation, especially if they are of this special population.
What is pediatric or elderly.
Requires life saving intervention
ESI Level 1
EMS arrives with a 14 year old male, fell while snowboarding and has a fracture in his L lower leg. He is awake, laughing with his buddies about the cute girl who helped him after he fell. Has had pain medication on route to hospital. VS WNL. Rates his pain a 4/10.
What is ESI Triage level 4, he needs one resource for his fractured leg. Otherwise stable and can tolerate waiting.
Appearance, work of breathing, and skin circulation are all included in this.
What is the pediatric assessment triangle, or across the room assessment.
We should tailor our approach to their age and development.
What are pediatric or other special populations.
Decreased baroreceptor sensitivity is common in this group.
What are the elderly special poplulations
Ventilation, intubation, IV medications
"I ran out of my pills yesterday afternoon. Can someone write me a prescription to get me through the weekend?" Says a 45 year old female with a prescription for labetalol and a history of high blood pressure. VS: BP 128/80, HR 74, RR 14 and SpO2 99% RA.
ESI Triage level 5, pt needs no resources. His vital signs are stable, he has no other medical complaints. He needs a prescription written and DC home.
One way we can calm a young child in the ED and communicate with them.
What is use distractions, get down on their level, communicate in simple terms, have parents help.
EMS will be here in 5 minutes with a G5P4 patient in distress. We will consult with this specialty.
What is OBGYN or Labor and Delivery STAT.
A common misconception about women of childbearing age.
It's not possible to be pregnant if using birth control.
Patients who qualify for an alert activation
ESI level 2
A 41 year old male was involved in a bike accident. He has a laceration on his left arm, along with a displacement, pain and swelling. He tells you "My helmet saved me."
What is ESI triage level 3, 2 or more resources. He at minimum will need an xray of his arm, and stitches for the lac.
My kids injury I told you about in yesterdays lecture...
What is a grade 4 kidney laceration, liver lac from getting run over by a car on his way to school.
EDC, LMP and GA all are part of this.
What is the gestational age of a fetus
Poor history, language barrier, lack of education
What are barriers to accurate triage
This is considered a high risk temperature in a 0-30 day old infant.
What is 100.4 or 38.0 C