Triaging PDF

TRIAGING PRESENTED BY ABENA KYEREW ABEBRESE  SORTING OUT CASUALTIES(TRIAGING) Triage, from the French word “trier”, literally means “to sort “.The aim is to bring “the greatest good to the greatest number of people “ – this is achieved through prioritizing limited r...

TRIAGING PRESENTED BY ABENA KYEREW ABEBRESE  SORTING OUT CASUALTIES(TRIAGING) Triage, from the French word “trier”, literally means “to sort “.The aim is to bring “the greatest good to the greatest number of people “ – this is achieved through prioritizing limited resources to achieve the greatest possible benefit. Patients are sorted with a scientific triage scale in order of urgency – the end result is that the patient with the greatest need is helped first.  THE TEWS (TRIAGE EARLY WARMING SCORE) calculator The SATS consists of 2 parts : the TEWS (part 1) and the discriminator list (part 2 ). The discriminator list follows after the TEWS. The provider needs to calculate the TEWS before moving on to the discriminator list. The first part ( or the TEWS ) is shown in table 3 ( adult version ). AKA 2024 3 AKA 2024 4 TRIAGE SHEET Patient’s name : …………………………………………………………………….. Age: ……………………… Sex : M F Chief Complaint : …………………………………………………………………………………………………………………. Date: ……………………………………………………….. Time of arrival : ………………………………. PART 1 : Triage Early Warning Score (TEWS) Triage Parameters Measured Value TEWS Score Mobility Respiratory Rate Heart Rate/Pulse Blood Pressure Temperature AVPU Trauma TEWS SCORE :……………………….. Initial Triage Colour RED ORANGE YELLOW GREEN BLUE PART 2 : The Discriminator List Does the patient need to be triaged to a higher colour based on the discriminator list? YES NO What was the discriminator? ……………………………………………………………………… PART 3 : Final Triage Colour AKA 2024 5 RED ORANGE YELLOW GREEEN BLUE  Blood Pressure and Heart rate monitor the cardiovascular system ( heart and blood flow ). You as the provider are interested in the systolic value only. That is the top value of the blood pressure ( BP = 120/80 , systolic BP or SBP = 120 ) Respiratory rate monitors the respiratory system (lungs) Temperature monitors thermoregulatory system (infections , hypothermia ) AVPU (A- alert , V – response to voice , P – response to pain , U – unresponsiveness) Mobility monitors the musculoskeletal system (bones and muscles )  Trauma refers to the presence of ANY injury ( bump, bruise , cut etc Example 1: comparing the observed basic vitals of the patient with a parameter on the TEWS calculate ( horizontally ) a score can be read off ( vertically). These scores are added together which gives the provider a total TEWS. Eg. Patient in wheelchair Respiratory rate = 18 Heart rate = 118 Blood pressure= 208/ 112 Temperature = 36.5  Patient Alert No trauma  TRIAGE COLOURS RED – Severely injured , but salvageable with rapid intervention and transportation to the correct facility Yellow / orange – injured, can be delayed in transport without serious deterioration. GREEN – Minimally injured BLACK / BLUE - Dead / non - salvageable AKA 2024 10  THE DISCRIMINATOR LIST The second part or the discriminator list is shown in table 6. This is the part that generates the actual triage colour (red ,orange ,yellow , green , blue )which will determine severity level and essentially also when the patient will be attended to. As with the TEWS , there are separate versions of this for infants , children and adults as seen in table 7 and 8 respectively. The TEWS score will only identify and classify a patient into an appropriate triage code if the physiology of the patient is altered from normal. The TEWS will be effective for most of the cases presenting to the triage provider. AKA 2024 11 There are however some discriminators that require special attention. It has been found that physiology alone does not pick up and classify patients with these discriminators safely and effectively. These discriminators therefore serve as a safety net for those patients with severe enough pathology to be seen more urgently. They are reclassified after the TEWS has been calculated. AKA 2024 13 AKA 2024 14 AKA 2024 15  TYPES OF TRIAGE MASS TRIAGE – Divides patients into triage categories based on their ability to move S.T.A.R.T TRIAGE – Determine the severity of injuries. ADVANCED TRIAGE – More fully assess injury priorities. AKA 2024 16  MASS TRIAGE Stands for MOVE, ASSESS , SORT , & SEND Based on patients ability to move and respond Move everyone who can move Assess everyone who can raise an arm or leg. Sort remaining victims – green/yellow/red/black. Send to treatment areas / hospital AKA 2024 17  S.T.A.R.T ( SIMPLE TRIAGE AND RAPID TREATMENT) Raid approach to sort large numbers of casualties Started before transport is available Use of tags to categorize patients Separates the injured into 4 groups : expectant ; immediate ; delayed ; minor AKA 2024 18  SORTING THE PATIENTS Remember that your job is to get to each patient as quickly as possible , conduct a rapid assessment , assign patient to broad categories based on their need for treatment. You cannot stop during this survey, except to correct airway and severe bleeding problems quickly. your job is to sort (triage) the patients. Other rescuers will provide follow – up treatment AKA 2024 19 THE FIRST STEP IN START: GET UP AND WALK The first step in start is to tell all the people who can get up and walk to move to a specific area. If a patient complains of pain on attempting to walk or move , do not force him or her to move. The patients who are left in place are the ones you must concentrate on. AKA 2024 20  INITIAL APPROACH Call out to the casualties , “if you can hear my voice , get up and come to me !” if they get up & walk to you , they are Minimal and you can use them as aids and security assets Call out ,”All of you that can hear me , raise your hand or foot!” if they raise a hand or foot , they are delayed. If the casualties don’t get up , or raise a hand/ foot , they are immediate or expectant ….. Get busy ! AKA 2024 21  THE SECOND STEP IN START Begin from where you stand. Move in an orderly and systematic manner through the remaining victims , stopping at each person for a quick assessment and tagging. The stop at each patient should never take more than one minute. REMEMBER : Your job is to find and tag the patients. Those who require immediate attention. Examine each patient , correct life – threatening airways and breathing problems , tag the patient with a red tag and MOVE ON!. AKA 2024 22  AIRWAY AND BREATHING If a patient is talking his airway is OK. If you find a patient who is not breathing and has no pulse , leave him and go on to the next. Do not compel personnel to try to revive a dead casualty , when the living still need their help. Reminder – This goes for a mass casualty situation with many truly injured people. AKA 2024 23  THE BENEFITS OF TRIAGE To expedite the delivery of time critical treatment for patients with life – threatening conditions To ensure that all people requiring emergency care appropriately categorized according to their clinical condition To improve patient satisfaction To decrease the patients overall length of stay To facilitate streaming of less urgent patients AKA 2024 24  SCENARIOS 1. Madam Beatrice Derry 45 years arrives at the ED at 10;26am assisted by her daughter with complaint of difficulty in breathing. On assessment her SpO2 is 63%, RBS 4.6mmol/L, temperature-37.1, pulse-96, respiration-28, BP- 121/56. She mentions that she has not had any injury. AKA 2024 25  SCENARIOS 2. Miss Norah Amoah a 30 year old arrives at the ED at 10:05am on a stretcher with complaint of weakness and difficulty in breathing. On assessment her SpO2 is 72%, RBS 4.0mmol/L, temperature-36.5, pulse-142, respiration-22, BP- 183/94. She is alert and has no history of an injury. AKA 2024 26  SCENARIOS 3. Mr Benjamin Okae an 81 year old man walks into the ED at 8:55am with complaint of moderate painful swollen right testicles. On assessment his SpO2 is 99%, RBS 5.4mmol/L, temperature-36.8, pulse-83, respiration-20, BP- 102/52. He is alert and has no history of an injury. AKA 2024 27  SCENARIOS 4. Mr Stephen Boafo an 18 year old man walks into the ED at 8:15am with complaint of deformed left hand due to trauma. On assessment his SpO2 is 96%, RBS 6.2mmol/L, temperature-36.1, pulse-77, respiration-18, BP- 99/64. AKA 2024 28 END OF PRESENTATION THANK YOU AKA 2024 29