triage based emergency care
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TRIAGE BASED EMERGENCY CARE
VASANTHA KALYANI,AIIMS,RISHIKESH
TRIAGE BASED EMERGENCY CARE
Emergency care:1. Emergency services is a crutial component of hospital services. The aspect
of speed, accuracy and sympathy are important in the emergency department
2. Major functions of an emergency department To treat unexpected patients with life threatening and routine conditions To provide service at all 365 days in a year To provide immediate appropriate and life searing case To proved services in efficient and effective manner To be sensitive to emotional needs of the patients and their relations To liaise with costs and police in emergency To be ready for disaster and mass casualty
TRIAGE A triage system is the essential structure by
which all incoming emergency patients are prioritized using a standard rating scale.
Category Treatment accurate
(Max. Waiting time)
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Immediate 10 minutes 30 minutes 60 minutes
120 minutes
TRIAGE SCALE:
Colour coding
Group/treatment accurate
Red tag. Immediate cann’t survive without immediate treatment
Yellow tag. Observation: need hospital care and Do re-triage
Green tag. Wait: need medical care for critical injuries
White tag. Dismiss: only minor injury no need of medical care
Black tag. Expectant: injures not able to survive with the given care
ADVANCED TRIAGE SCALE: COLOUR CODES
Immediate 10 minutes 30 minutes 60 minutes
120 minutes
Airway Obstructed/ partially obstructed
Patent Patent Patent Patent
Breathing Severe respiratory distress/absent respiration hypoventilation
Moderate respiratory distress
Mild mild respiratory distress
No R.S No R.S.
Circulation Severe homodynamic compromises/ absent circulation/ uncontrolled haemorrhage
Moderate hemodynamic compromises
Mild hemodynamic compromises
No H C No H C
Disability GCS ≤9 GCS 9-12 GCS ≥12 Normal Normal
ADULT PHYSIOLOGICAL PREDICTORS FOR TRIAGE
Triage nurse must ensure that patients with
physiological abnormalities are not delayed
by the triage process and are allocated to
provide ongoing assessment and treatment of
their condition.
RECOMMENDED TRIAGE METHOD
The collection of physiological
parameters at triage requires the health
professionals to make the best use of
their senses to detect abnormalities.
Assess the following:
Chief complaint
General appearance
Airway
Breathing
Circulation
Disability
Environment
Limited history
Co-morbidities
PATIENT PRESENT FOR TRIAGE SAFETY HAZARDS ARE CONSIDERED
Quick evaluation to check patient stable .
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Assign appropriate Triage category In
response to clinicalAssessment data
Differentiate Predictors of poor outcome from Other
date collected During the triage Assessment
4- IDENTIFY PATIENTS 5- ASSIGN APPROPRIATE
Who have evidence of (or)
Case at high risk of
physiologic
instability
Triage category In Assessment data response to clinical
ALLOCATE STAFF PROCEED The patient including
brief handover to allocated staffmembers
Start the care as per the hospital protocalf
MENTAL HEALTH TRIAGE
Treatment code Description Care 1. Immediate Definite danger to
violent life (self or others)
Supervision 1:1 observation
2. Emergency within 10 minutes
Probable risk of danger to self or others
Supervision prompt assessment
3. Urgent within 30 minutes
Possible danger to self or others agitation/confused
Supervision/observation
4. Semi-urgent within tensions
Moderate distresss no immediate risk
Supervision intermittent observation
5. Non- urgent No danger to self or others
General observation
MENTAL HEALTH TRIAGE
PAIN- TRIAGE
Pain – triage scale Very severe – emergency Moderately severe – urgent (30 mts)Moderate – semi urgent (60 mts)Minimal – non- urgent
PAIN- TRIAGE SCALE:
PAEDIATRIC TRIAGE
1. The clinical priorities and principles of urgency for infants children and adolescents are the same as those for adults
2. Determining urgency will require recognition of serious illness, some features of which may be different is infants and children
3. The value of parents and their capacity to identify devations from normal in their child’s level of function should not be underestimated
Decreased feeding Decreased activity
Breathing difficulty Being pale or hot
Dehydration Febrile illness of child under 3 months
Decreased urination
PAEDIATRIC TRIAGE:
assessment immediate Emergency 10 minutes
Urgent 30 minutes
Semi urgent 60 minutes
Non- 120 minutes
Airway Obstructed severe Respiratory Distress
Partially obstructed with moderate R. D
Patent mild R. D
Patent Patent
Circulation Absent circulation significant body cardia HR ≤ 60 in infaet
Circulation present
Circulation present
Circulation present
Circulation present
Disability GCS ≤ 8 GCS 9-12 GCS ≥13 Normal GCS Normal GCS
TRIAGE AND PREGNANT MOTHER
The triage nurse needs to be aware of the normal physiological and anatomical adaptations of pregnancy because these will influence assessment
Triage should consider well being of both the mother and the foetus and potential threat to each other
The pregnant mother may present with any disease
TRIAGE AND PREGNANT MOTHER
Assessmen on volume and colour of per vaginal loss.
Bright red – active bleeding
Brownish red - usually old bleeding
Shoulder tip pain – indication ectopic pregnancy
Abdominal pain - ruptured ectopic pregnancy
TRIAGE NURSES ROLE ON PREGNANT MOTHER PRIOR TO 20 WEEKS
Antepartun haemorrhage
Preeclampsia
Pre-term rupture of membrane
Hypertension mother 140/90 mmHg
20 WEEK ONWORDS
Changes in oxygen saturation
Alteration in blood pressure (either high or low)
Active vaginal bleeding
Absent or diminished foetal movements
URGENT THREAT TO FOETAL WELL BEING
Nurses performing the role of triage must have appropriate
education and supersized practice prior to practice independent
triage
Documentation must be accurate and contemporaneous
Clear and understating duty of case
Importance of re-triaging
Policies and protocols should be readily accessible
Preservation of forensic evidence
MEDICO- LEGAL ISSUES OF TRIAGE PRACTICE NURSES ROLE
Infrastructure requirement
Provision of proper and adequate manpower and training
requirements
Standard protocols
STANDARDIZATION OF EMERGENCY SERVICES IN HOSPITALS:
Mismatch between health care facility capacity and demand
population
Lack of infrastructure due to default or lack of funds or poor
planning
Inadequately equipped health care facilities due to inadequately
skilled manpower
Lack of standard operating procedures regarding handling of
patient
Lack of accountability
ISSUES TO OVERCOME
Total monthly attendance:
Total number of patients
attending emergency
department in a month
Total monthly:
Admissions: total number of
patients admitted through
emergency in a month.
Disease wise classification of
patients as per scope of
services document
Number of patients
referred in from periphery
with details of referring
institute along with reason for
referral.
Number of patients referred
out to other hospital with
details of referring institute
along with reason for referral.
Number of successful CPR out
of total CPR done in a month.
QUALITY INDICATIONS OF EMERGENCY CARE
PATIENTS SAFETY INDICATORS Time to initial assessment
Time to treatment
OUTCOME INDICATORS
Total number of emergency
cases per thousand
population
Total number of trips per ambulance
Total number of trauma
cases treated per 1000
emergency cases
Total number of poisoning cases treated
per 1000 emergency
cases Total number of cardiac cases treated per
1000 emergency
cases
Total number of obstetric cases
treated per 1000
emergency cases
Total number of resuscitation
done per 1000 population
Proportion of patients
attended at night
CONCLUSION1. Receiving of the patient 2. Registration of the patient 3. Identification of the patient4. Initial assessment of patient 5. Reassessment of patient 6. Shifting/transfer of patient within hospital 7. Referral of patients 8. Discharge of the patient9. Patient care protocols
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THANK YOU
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