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Optometric Staff | Course Notes

OA6 – 1CE

Emergency Triage

Saturday, February 25, 2017

10:55 am – 11:50 am Oxford/Prince of Wales

Presenter: Brad McDougall

Dr. McDougall has practiced in downtown Vancouver for the last 22 years, and is a principal partner at the Vancouver Block Optometrists on Granville Street. Dr. McDougall practices full scope, primary care optometry, with an emphasis in low vision. He is a clinical director with the national Special Olympic Games, and has a passion for traveling to areas in the developing world to provide eye care to those in need.

Course Description

Properly triaging complaints, whether on the telephone or in person, can make a critical difference between a good and bad outcome, and can even play a role in disciplinary or legal action. This course will include a review of ocular triage, specific red flag findings and will help develop phrases and language to use while triaging with patients.

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Optometric Staff | Course Notes

NOTES:

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TRIAGE: EVALUATING AND PRIORITIZING PATIENT EMERGENCIES Brad McDougall, BSc., O.D. Vancouver Block Optometrists & ottico brad@ottico.ca

Triage ! Evaluating and prioritizing patient emergencies according to

the level of urgency !  triage of patient complaints over the phone can be a daunting

task !  in a minute or two a patient must be interviewed, their

symptoms reviewed and the correct level of urgency gauged

Communication breakdowns: !  20 patients might call with the same problem, yet no two of

them describe their symptoms in the same words.

! How each person perceives their situation

! The patient will rarely understand the complete scope of what is wrong with them

!  Many patients may not adequately convey their needs

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Best Mindset: ! Be investigative ! Err on the side of caution ! Don’t just turn people away ! Empathetic ! Patience and care ! A measure of firmness for those who wont comply

The three levels of triage: ! The Emergent or Immediate Case: Needs to be seen

within the hour.

! The Urgent Case: Needs to be seen the same day.

! The Priority Case: Needs to be seen within days.

THE EMERGENT CASE ! True emergencies are rare, but have the most consequence. ! Seen ASAP, within the hour, or directed where to go ! Sudden, severe PAIN: Chemical burns, Trauma, Penetrating injury, Blood from eye ! Sudden vision loss- monocular Full Retinal Detachments, Central Artery Occlusion

THE URGENT CASE ! Seen the same day ! Red Eyes ! Contact lens related red eye- “I slept with them” ! Flashes or floaters ! Angle closure attack ! Sudden loss of vision, or double vision ! Double vision or sudden unequal pupil size, or drooping lids ! Halos around

Red eye flow sheet

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Central Corneal Clouding Angle Anatomy

Angle Closure attack Exceptions: ! Any monocular patient with vision complaints should be

considered an urgent case as well. Every effort must be made to maintain the sight in this patients’ good eye.

! Very high Prescriptions

The Priority case ! The priority cases should be seen within several days of their

initial complaint.

! Slow onset blurring of vision ! Seasonal allergy complaints ! Lost contact or glasses ! Headaches and associated symptoms

Questions: ! What is the chief complaint or problem? ! When did the problem start or how did it happen? ! Was it a sudden or gradual onset? !  Is the problem in just one eye or both? ! Are there any flashes of light, floaters or what might appear

as a curtain or shade over the vision?

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Questions: ! Has there been vision loss or change? !  Is it constant or intermittent in manifestation? If intermittent,

how often? ! Rate the severity of discomfort on a scale of 0 to 10. ! Does the problem seem stable or is it getting better/worse?

Consequences and Ethics: ! Severe pain !  Irreparable loss of ocular function !  If you cant help you should be able to suggest a course of

action ! Must educate and convey information clearly to promote

compliance