ED 1B

Question 1

Category 1 Immediate
Airway 
Breathing
Circulation 
Disability

Answer 1

• Obstructed/ partially obstructed
• Severe respiratory distress/absent respiration/ hypoventilation
• Severe haemodynamic
  compromise/ absent circulation
  Uncontrolled haemorrhage
• GCS <9

Question 2

Category 2 10 minutes
Airway 
Breathing
Circulation 
Disability

Answer 2

• Patent
• Moderate respiratory distress
• Moderate haemodynamic
  compromise
• GCS 9–12

Question 3

Category 3 30 minutes
Airway 
Breathing
Circulation 
Disability

Answer 3

• Patent
• Mild respiratory distress
• Mild haemodynamic
  compromise
• GCS >12

Question 4

Category 4 60 minutes
Airway 
Breathing
Circulation 
Disability

Answer 4

• Patent
• No respiratory distress
• No haemodynamic
  compromise
• Normal GCS

Question 5

Category 5 120 minutes
Airway 
Breathing
Circulation 
Disability

Answer 5

• Patent
• No respiratory distress
• No haemodynamic
  compromise
• Normal GCS

Question 6

Allocating Patients to an area in ED

Answer 6

RESUSCITATION BAY 
MAIN ARENA BED
FAST TRACK 
Sub acute area
(no cardiac monitor)
Waiting Room

Question 7

Re- Triage

Answer 7

A patients clinical status can CHANGE or additional information
may be given.
This may impact the urgency to have a bed or be seen by an
emergency Dr.
Patient’s are encouraged in triage to come forward if there are
any changes to their condition while they are waiting.
When a patient is re- Triaged, both the initial triage code and
subsequent code must be documented.

Question 8

COMMUNICATION AT TRIAGE

Answer 8

Patient communicates health concerns to nurse
-Nurse asks questions.
-Patient answers
-Nurse checks for patients understanding
Nurse informs patient of triage outcome. What
comes next? and checks for patient
understanding.

Question 9

Barriers to Triage

Answer 9

! Physical Environment; distracting noises, lack of privacy
! Time constraints
! Language use; NESB, medical jargon
! Patient has a cognitive impairment
! Nature of health concern. The presenting problem may
be embarrassing to the patient or anxiety provoking.
Using euphemisms can be very confusing.
! Emotions, presenting to emergency can be extremely
stressful for some people. Stress can lead to Aggression.
! Unrealistic expectations and assumptions. Every patient
believes that their health concern is the most urgent.

Question 10

Overcoming Barriers

COMMUNICATION SKILLS.

Answer 10

• Remain calm.
• Listen, interpret, explain with care, and check for understanding.
• Use simple language. Don’t ask if a patient has voided today, asked when is
  the last time you passed urine.

Question 11

Understanding the patients basic human needs

Answer 11

To be understood

• To feel welcome
• To feel important
• need for comfort, reassurance

Question 12

Special presentations

Answer 12

! Pregnancy
! Paediatric
! Mental Health
! COVID
! Cancer patient, chemotherapy

Question 13

The Four-Hour NEAT

Answer 13

is defined as a target
whereby 85% of patients must spend less than
four hours in the emergency department (ED)
from arrival to admission, transfer or discharge.

Question 14

MAIN ARENA NURSE

Answer 14

Nurse taking over care will first Don PPE!
Then do a primary assessment on the patient.
Ask- Why have you presented to emergency?
Conduct vital signs.
gather medical hx
help patient change into hospital gown
record patient belongings, put clothes in pink bag with label.

Question 15

SEPSIS KILLS

Answer 15

RECOGNISE the risk factors, signs and symptoms
of sepsis
RESUSCITATE with rapid intravenous fluids and
antibiotics within 1 hour,
REFER to a senior clinician

Question 16

Statistics on Sepsis

Answer 16

Sepsis is a time critical medical emergency and a
leading cause of death worldwide.
In Australia at least 55,000 people develop sepsis
each year and 8,000 of them die from sepsis-related
complications
A patient with severe sepsis or septic shock is 5 times
more likely to die then a patient with a AMI or stroke.