Podcast
Questions and Answers
In the context of medical triage, what is the primary objective that guides the allocation of treatment and resources?
In the context of medical triage, what is the primary objective that guides the allocation of treatment and resources?
- Maximizing the number of survivors by strategically distributing resources based on patient needs. (correct)
- Prioritizing patients based on their ability to pay for treatment.
- Ensuring that every patient receives comprehensive care, regardless of the severity of their condition.
- Focusing on patients with the highest likelihood of full recovery, even if their conditions are less urgent.
Why is the 'red-flagging' feature in eConsults considered important in digital triage mechanisms within GP practices?
Why is the 'red-flagging' feature in eConsults considered important in digital triage mechanisms within GP practices?
- It helps in promoting specific health services to patients based on marketing algorithms.
- It primarily aims to reduce the workload of healthcare professionals by automating patient assessments.
- It quickly identifies and advises patients to seek urgent care for potentially critical conditions. (correct)
- It facilitates routine follow-ups without necessarily impacting the urgency of care.
During Stage 2 of the chiropractic triage process, when determining the origin of a patient's pain, which assessment findings would most strongly suggest a neuro-orthopedic referral?
During Stage 2 of the chiropractic triage process, when determining the origin of a patient's pain, which assessment findings would most strongly suggest a neuro-orthopedic referral?
- Evidence of nerve compression with corresponding sensory or motor deficits. (correct)
- Identification of myofascial trigger points leading to localized pain.
- Observation of centralization signs during repeated movements.
- Discovery of dynamic instability during movement assessments.
In the context of initial patient triage, what key factors should healthcare providers consider when determining if a patient has a serious pathology requiring immediate referral?
In the context of initial patient triage, what key factors should healthcare providers consider when determining if a patient has a serious pathology requiring immediate referral?
After ruling out the need for urgent referral during triage of a patient with musculoskeletal complaints, what is the next critical step in the triage process?
After ruling out the need for urgent referral during triage of a patient with musculoskeletal complaints, what is the next critical step in the triage process?
How might pain attributed to a 'mechanical' cause typically present differently from pain caused by a 'systemic inflammatory condition'?
How might pain attributed to a 'mechanical' cause typically present differently from pain caused by a 'systemic inflammatory condition'?
What clinical findings would strongly suggest a 'systemic inflammatory condition' as opposed to a 'local inflammatory condition'?
What clinical findings would strongly suggest a 'systemic inflammatory condition' as opposed to a 'local inflammatory condition'?
What key signs and symptoms differentiate septic arthritis from other inflammatory conditions?
What key signs and symptoms differentiate septic arthritis from other inflammatory conditions?
What assessment findings are most indicative of nerve compression rather than a simple sprain or strain?
What assessment findings are most indicative of nerve compression rather than a simple sprain or strain?
Which of the following pain patterns is most indicative of neoplasm rather than a mechanical or inflammatory condition?
Which of the following pain patterns is most indicative of neoplasm rather than a mechanical or inflammatory condition?
In differentiating between a fracture and dislocation from a soft tissue injury like a sprain or strain, which assessment finding is most critical?
In differentiating between a fracture and dislocation from a soft tissue injury like a sprain or strain, which assessment finding is most critical?
When formulating a working diagnosis and management plan, what is the most critical question to consider in the context of a patient's symptoms?
When formulating a working diagnosis and management plan, what is the most critical question to consider in the context of a patient's symptoms?
During triage, a patient reports sudden, severe lower back pain radiating down their left leg, accompanied by new-onset bowel and bladder dysfunction. What is the MOST appropriate immediate action?
During triage, a patient reports sudden, severe lower back pain radiating down their left leg, accompanied by new-onset bowel and bladder dysfunction. What is the MOST appropriate immediate action?
A patient presents with progressive, unremitting hip pain that is not relieved by rest or over-the-counter analgesics. They also report unintentional weight loss, fatigue, and a low-grade fever. How should you triage this patient?
A patient presents with progressive, unremitting hip pain that is not relieved by rest or over-the-counter analgesics. They also report unintentional weight loss, fatigue, and a low-grade fever. How should you triage this patient?
A 30-year-old marathon runner reports localized anterior knee pain that increases with prolonged sitting and descending stairs. There's no history of trauma or swelling. Which triage category is MOST likely?
A 30-year-old marathon runner reports localized anterior knee pain that increases with prolonged sitting and descending stairs. There's no history of trauma or swelling. Which triage category is MOST likely?
A patient with a history of rheumatoid arthritis presents with increased boggy swelling, warmth, and redness in multiple joints, accompanied by stiffness lasting more than an hour each morning. Which triage category is MOST appropriate?
A patient with a history of rheumatoid arthritis presents with increased boggy swelling, warmth, and redness in multiple joints, accompanied by stiffness lasting more than an hour each morning. Which triage category is MOST appropriate?
A patient reports recent onset of sharp shoulder pain radiating down the arm into the hand, associated with numbness and tingling in the thumb and index finger. Tapping over the carpal tunnel reproduces the symptoms. Which triage category is MOST likely indicated?
A patient reports recent onset of sharp shoulder pain radiating down the arm into the hand, associated with numbness and tingling in the thumb and index finger. Tapping over the carpal tunnel reproduces the symptoms. Which triage category is MOST likely indicated?
A patient states they twisted their ankle while stepping off a curb. The ankle is immediately painful and swollen and they cannot bear weight on it. Based on this limited information, which triage category is most appropriate?
A patient states they twisted their ankle while stepping off a curb. The ankle is immediately painful and swollen and they cannot bear weight on it. Based on this limited information, which triage category is most appropriate?
During a medical triage scenario in an emergency room, a patient presents with severe chest pain, shortness of breath, and dizziness. The triage nurse quickly assesses the patient's vital signs. What is the next MOST critical step?
During a medical triage scenario in an emergency room, a patient presents with severe chest pain, shortness of breath, and dizziness. The triage nurse quickly assesses the patient's vital signs. What is the next MOST critical step?
A patient presents with a history of chronic lower back pain. They have tried physical therapy, chiropractic care, and pain medications without lasting relief. How would you approach the triage process and subsequent care?
A patient presents with a history of chronic lower back pain. They have tried physical therapy, chiropractic care, and pain medications without lasting relief. How would you approach the triage process and subsequent care?
A patient mentions that their pain is now relieved by activity, and worsened by rest. Further, they have noticed stiffness that worsens after periods of inactivity, lasting greater than 30 minutes. History suggests the patient is most likely dealing with a situation that is:
A patient mentions that their pain is now relieved by activity, and worsened by rest. Further, they have noticed stiffness that worsens after periods of inactivity, lasting greater than 30 minutes. History suggests the patient is most likely dealing with a situation that is:
In the context of triage, why is it important to recognize that ‘Not all of the bullet points need to be present to triage to a category’ and ‘some are more important than others’?
In the context of triage, why is it important to recognize that ‘Not all of the bullet points need to be present to triage to a category’ and ‘some are more important than others’?
Considering that triage is only the first step in treatment, why is it important, even when ‘some conditions don't really fit in any category’?
Considering that triage is only the first step in treatment, why is it important, even when ‘some conditions don't really fit in any category’?
After performing digital triage, a patient is advised to seek urgent care. What steps may an eConsult / digital triage mechanism have followed to produce this recommendation?
After performing digital triage, a patient is advised to seek urgent care. What steps may an eConsult / digital triage mechanism have followed to produce this recommendation?
Considering the flowchart used by chiropractors, which features are included at stage 3?
Considering the flowchart used by chiropractors, which features are included at stage 3?
Flashcards
Medical Triage
Medical Triage
Sorting patients based on their need for care to maximize survivors.
Triage in GP Practices
Triage in GP Practices
Used in GP practices to determine patient's urgency, help type, and suitable professional.
First Triage Goal
First Triage Goal
Initial step to identify serious pathology for immediate referral.
Mechanical Pain
Mechanical Pain
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Systemic Inflammatory condition
Systemic Inflammatory condition
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Local Inflammation
Local Inflammation
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Septic Arthritis
Septic Arthritis
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Nerve Compression
Nerve Compression
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Neoplasm
Neoplasm
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Strain
Strain
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Sprain
Sprain
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Fracture/Dislocation
Fracture/Dislocation
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Urgent Referral
Urgent Referral
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Triage benefit
Triage benefit
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Study Notes
- Triage is a case-based learning skill aimed at introducing and explaining the triage of patients.
- This lecture aims to help you understand the purpose of triage, be familiar with triage categories, and apply triage to clinical cases to identify the most likely category.
Medical Triage
- Is the the sorting and allocation of treatment to patients, especially battle and disaster victims, according to a system of priorities designed to maximize the number of survivors.
- It is the sorting of patients in an emergency room according to the urgency of their need for care.
- It is the assigning of priority order to projects based on where funds and other resources can be best used, are most needed, or are most likely to achieve success.
Triage in GP Practices
- Considers why the patient sought help, the kind of help required, and how quickly they need it.
- Determines who the best person is to assist them, and when and where they should be seen.
- eConsults/digital triage mechanisms are equipped with "red-flagging" systems to advise on the need for urgent care.
Chiropractic Triage Process
- Stage 1: Patient presents to a chiropractor and is assessed for serious pathology requiring referral.
- Stage 2: Determine where the pain is coming from.
- Stage 3: Identify any perpetuating factors.
Triage Assessment
- Involves initially assessing the patient to identify any serious pathology requiring immediate referral.
- Questions to ask include: How urgently do they need to be referred, and to where and how?
- If there's no need for an urgent referral, categorize the patient into one of the following groups to being forming a diagnosis for musculoskeletal disorders:
- Mechanical
- Systemic inflammatory condition
- Local inflammatory condition
- Septic arthritis (infection)
- Nerve compression
- Neoplasm
- Sprain/strain
- Fracture/dislocation
Mechanical Issues
- Pain varies with physical activity and time.
- The patient appears well.
- The onset of pain is sudden, occurring after unguarded movement or injury.
- No marked swelling or warmth is associated.
- Limited to one joint, usually lessened by rest and aggravated by activity.
Systemic Inflammatory Conditions
- Symptoms can include boggy swelling, warmth, and redness of the joint, frequently symmetric.
- Synovitis and systemic disease are common.
- Subcutaneous nodules may be seen on extensor surfaces.
- Severe joint and valgus deformities are common.
- Extensor tendon ruptures may be noted.
- Pain is relieved with activity and aggravated by rest and inactivity.
- Morning stiffness lasts longer than 30 minutes, and night pain is present.
Local Inflammatory Conditions
- Localized boggy swelling and warmth may be present, along with night pain.
- There is relief with activity, but the condition is aggravated by rest and inactivity.
- Local morning or rest stiffness lasts more than 30 minutes.
- It affects only one area, with no signs of systemic illness.
Septic Arthritis (Infection)
- Red, hot, swollen joint.
- It is very painful and accompanied by fever, fatigue, and a loss of joint ROM.
Nerve Compression
- Causes include pain, weakness, sensory loss, reflex loss, and paresthesias in the dermatomal and/or myotomal distribution of the affected nerve.
- Stretching the nerve may increase the pain, and tapping over the nerve may result in distal tingling (Tinel sign).
Neoplasm
- Presents with unremitting pain, often waking the patient from sleep.
- There is no comfortable position to relieve pain, and may be accompanied by fever, weight loss, and fatigue.
Strain
- Affects muscles and tendons.
Sprain
- Affects ligaments.
Fracture & Dislocation
- Sudden onset associated with a history of trauma, except in cases of osteoporosis and stress fractures.
- Unremitting pain at onset, aggravated by movement of joint/stressing of the involved bone.
- Localized (to diffuse) tenderness, deformity, and/or instability may be present.
- Ecchymosis and swelling may occur, and increased pain with percussion or vibration may be detected.
Important Considerations
- Not all bullet points need to be present to triage to a category, you are looking for the best fit.
- Some conditions fit cleanly into one category, and some do not easily fit in any category.
- Focus on the most important symptoms, highlighted in red, to increase the probability.
- When the presentation fits well with one or more categories, this approach can help narrow the probable diagnoses.
Working Diagnosis Questions
- Are the presenting symptoms related to a visceral disease or a serious/potentially life-threatening disease?
- What tissue is responsible for generating the pain?
- What is happening with this patient that causes the primary pain generator to continue to generate pain?
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