Introduction Flashcards
Approach to the Emergency Patient
Pressures of time and volume Variety of conditions faced Paucity of information available Limitation of therapeutic options Constraints of disposition
Pressures of Time and Volume
Turbulent flow
Treat first, ask questions later
May have 15 minutes total with each patient
Be aware of priorities among patients
Variety of Conditions
Be ready to shift domains rapidly
Paucity of Information
Old records unavailable
Poor historians or unable to speak and family unavailable
Information gathering limited
Limited Therapeutic Options
Provide symptomatic treatment
Tolerance for mistakes is very low
“Treat and street”
Constraints of Disposition Components
Sick or not?
Treat or not?
Admit or discharge?
Bedside Evaluation
Build working relationship with patient Get on patient's level Think aloud Listen to your patient, don't interrupt Watch out for the helpful family member
3 Options of Patient Disposition
Admit
Discharge
Transfer
3 Common Pitfalls to the Approach of the Emergency Patient
Tunnel vision
Inability to see “forest for the individual trees”
Failure to attend to the patient
Define Triage
To sort or choose
Define Disaster Triage
Where casualties overwhelm the ability to provide care
Routine ED Triage
Goal is to sort according to priorities of medical need
4 Categories in Disaster Triage
Immediate
Delayed
Minimal
Expectant
Describe the Immediate Category in Disaster Triage
Life threat that is easily addressed
Describe the Delayed Category in Disaster Triage
Patient can wait without risk
Describe the Minimal Category in Disaster Triage
Patient requires little intervention
Describe the Expectant Category in Disaster Triage
Patient will likely die with or without any interventions
Goals of Routine ED Triage
Define and classify urgency based on complaint and presentation
Ensure patient safety
Facilitate care and flow through ED
Satisfy legal requirements for “screening”
5 Levels of Routine ED Triage
Immediate Very urgent Urgent Semi-urgent Non-urgent
Describe Immediate or Level 1 of ED Triage
Complaint or condition requires immediate assessment and intervention
ANY delay represents unacceptable risk
Examples of Immediate or Level 1 Status
Cardiac arrest
Anaphylaxis
Compromised airway
Describe Very Urgent or Level 2 Status of ED Triage
Complaint or condition require assessment and intervention within 10 minutes
Examples of Very Urgent or Level 2 Status
Chest pain
CVA
Significant bleeding
Major trauma
Describe Urgent or Level 3 Status in ED Triage
Complaint or condition require assessment and intervention within 30-60 minutes
Examples of Urgent or Level 3 Status
Toxic ingestions
Severely painful conditions
Multiple organ system involvement
Abnormal, non-emergency vital sign or test result
Describe Semi-Urgent or Level 4 Status in ED Triage
Complaint or condition require assessment and intervention within 1-2 hours
Examples of Semi-Urgent or Level 4 Status
Lacerations
Long bone fractures
Dislocations without neuromuscular compromise
Describe Non-Urgent or Level 5 Status in ED Triage
Complaint or condition requires assessment and intervention within 2-4 hours or longer
Examples of Non-Urgent or Level 5 Status
Suture removal
Wound recheck
Minor rash
