Assessment of Critically Ill Child - Triaging Flashcards
Who is a critically ill child?
A child who requires or potentially requires high dependency or intensive care
When do most deaths of children admitted to the hospital occur? How could they be prevented?
Within 24 hours of admission.
Some of these deaths could be prevented if very sick children are identified early and treated immediately
How does triaging prevent deaths in children?
Facilitates rapid assessment and triage for all children presenting to hospital to identify those needing immediate emergency care
Steps in Management of the Sick Child
Triage (SATS)
Primary assessment (ABCDE approach)
Secondary assessment (SAMPLE history - in community settings/detailed history and physical examination)
Tertiary Assessment (Lab and Radiology Investigations)
Treatment (Definitive)
What is Triage?
The process of rapid assessment of a patient with a view to define urgency of care and priorities in treatment.
From the french word trier - to separate/sort.
First step in management of a sick child reporting to a health facility
What does Triage help in?
It helps in the rational allocation of limited resources, when demand exceeds availability in low resourced settings.
Expedites delivery of time critical treatment for patients with life threatening condition.
Improve patient’s satisfaction and decrease patients overall length of stay - ‘cause of less complications leading to faster recovery.
What is the purpose of Triage?
Identify sick patients before they become too sick and to prevent cardiac or respiratory arrests and/or ICU admissions. (Outcomes for children who develop cardio-pulmonary arrest are poor).
Most triaging systems seek to identify
Potential respiratory failure
Potential circulatory failure
Potential neurological failure & institute management preventing arrest.
Examples of conditions requiring immediate treatment to prevent death or disability
Respiratory distress / failure
Shock
Altered Sensorium/Coma
Anaphylaxis
Non-trauma surgical emergencies
Trauma
When should Triage take place?
As soon as the sick child arrives at the hospital, before any administrative procedures such as registration
Who should Triage?
All staff working in a health care facility should be trained on how to carry out rapid assessment of sick children and triage
Example of Triage systems
South African Triage Scale (SATS)
WHO-ETAT (Emergency Triage Assessment and Treatment)
Canadian Triage and Acuity Scale
Paediatric Triage according to F-IMNCI module: EPN (Emergency, Priority and Non-Urgent) system
Emergency Severity Index
Describe the South African Triage Scale (SATS)
+2 part tool
*TEWS (Triage Early Warning Score)- detect very urgent & urgent signs, measure vital signs (each given a score)
*Discriminators - Based on presence of emergency signs/senior health officer discretion, TEWS not needed - straight to resuscitation.
+2 versions
Adult (>12) and Paediatric (<12) version
+5 colours – Red, Orange, Yellow, Green and Blue (Based on priority level)
SATS Five Step Approach
Step 1 (Red): Look for emergency signs (if present, don’t continue steps but resuscitate) and ask for presenting complaint
Step 2(Orange & Yellow): Look for very urgent (if present, skip to step 3) then urgent signs (if no emergency signs present)
Step 3(Grey): Measure the vital signs and calculate the TEWS (If 7/more, resuscitate
Step 4(Blue): Check key additional investigations (can change TEWS - if 7/more resuscitate)
Step 5: Assign final triage priority level
What are the Triage Scores?
Very Urgent (Orange): TEWS 5 or 6
Urgent (Yellow): TEWS 3 or 4
Routine (Green): TEWS 0, 1 or 2
Deceased (blue)
Senior Healthcare professionals discretion
Approach to SATS Emergency Signs
ABC-c-c-DO approach: Airway-Breathing-Circulation/Coma/Convulsion-Dehydration-Others
Patient with any emergency signs should be sent directly to the resuscitation area; not necessary to calculate TEWS
