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ED Triage > policy and procedures > Flashcards

policy and procedures Flashcards

1
Q

when to escalate vital signs to dr?

A

changes in breathing pattern
- o2 if sob, tachypnea, desaturation

abnormal VS: SBP<100, HR<60 or >=100, spo2 <=93 (<88 for COPD)

new onset fever T>=37.5

NEWSII 3 in single parameter, 5-6, if 7 or more then resus

if GCS deteriorates, check with senior first
- inform if 2 or more, change in pupil size and reflex, limb strength deteriorates
- to resus if 4 or more

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2
Q

indications for CLC

A

NL/NES as primary or secondary dx
AMS including AI

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3
Q

describe the GCS scale and scoring

A

E1 = none, E2 = pain, E3 = voice, E4 = spontaneous, EC = closed

V1 = none, V2 = incomprehensible sound, V3 = inappropriate words, V4 = confused, V5 = orientated, VT = trachy

M1 = none, M2 = abnormal extension, M3 = abnormal flexion, M4 = flexion, M5 = localises pain, M6 = obeys commands

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4
Q

describe the scoring for pupil reflex and limb strength

A

pupil size: 1-8mm
pupil shape: round, irregular
pupil reflex: brisk, sluggish, fixed, EC, NT

power 0 = none, 1 = minimal, 2 = AG, 4 = mild weakness, 5 = normal

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5
Q

indications for NVA

A

MSK injury, post-orthopedic procedure +/- application of restrictive cast

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6
Q

describe the NVA and scoring

A

pain = pain score
color (pallor) = pink, pale, blue, mottled
motor (paralysis) = active, flicker, absent
> UL: thumbs up, oppose thumb/pinky, adduction of fingers
> LL: dorsi/plantarflexion
sensation (paraesthesia) = hyper, normal, reduced, absent, NA
> UL: web of 1st/2nd, tip of index/middle finger, fat pad of pinky
> LL: tip of 2nd toe, distal-proximal midsole
poikilothermia = warm, cool, cold
pulse = strong, weak, absent, NA
> UL: radial, brachial
> LL: dorsalis pedis, posterior tibialis
swelling = absent, slight, moderate, severe
CRT = <3s, >3s, NA

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7
Q

what is the indication of lung auscultation at triage?

A

SOB

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8
Q

signs upon auscultation that indicates to go resus

A
  • accessory muscle use
  • aggression
  • silent chest
  • stridor
  • spo2 < 90%
  • speech: unable to speak full sentence in one breath
  • exhausted/confused
  • RR > 30
  • HR > 120
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9
Q

what is the indications of stroke scale at triage?

A

unilateral weakness/numbness
new neurological sx with past stroke hx
slurred speech
headache 8-10/10
ataxia (poor coordination, gait)
giddiness with confusion
vertiginous giddiness

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10
Q

describe the stroke scale and the relevant documentation

A

pronator drift, speech, facial palsy
- document ONLY positive domains, unless all positive

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11
Q

what are the inclusion and exclusion criterion for stroke activation?

A

include: presentation of stroke symptoms within 6h of discovery
exclude: poor premorbids (ie. bedbound/uncommunicative), TIA, hypoglycemia (sx resolved after), pure sensory sx (ie. only numbness)

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12
Q

what is symptom discovery time vs. last seen well?

A

symptom discovery is when the symptoms are first noted by pt/nok
last seen well is when nok last saw patient asymptomatic (made inaccurate if patient went to sleep)

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13
Q

what are the indications of ECG at triage

A

bradycardia (<60)
tachycardia (>100)
hypokalemia (<2.5)
hyperkalemia (>6)
epigastric pain (>20yo)
chest pain (>20yo)
chest trauma
seizure
syncope
palpitations

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14
Q

what are the indications of UC10 at triage

A

flank/loin/lower abdominal pain
urinary symptoms
SBP 200 or more, DBP 120 or more
referred by OPS for HTN
HC ‘HI’

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15
Q

what are the indications of HC at triage

A

DM
AMS, giddy, seizure (syncope), weakness
lumps, bumps, abscess, chronic wounds, skin infections

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16
Q

what are the indications of UPT at triage

A

F/9-60yo + lower abdominal pain/require XR at triage, unsure if pregnant
amenorrhea
menorrhagia

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17
Q

what are the indications of blood taking at triage

A

FBC = dengue review clinic
CK = rhabdo review clinic

18
Q

what are the indications of CXR at triage, and what views are indicated?

A

CXR PA/AP = isolated chest trauma within MCL, cough x1/52, creps, referral for dengue
CXR PA + oblique = isolated chest trauma lateral to MCL

19
Q

what are the indications of limb XRs, and what XRs can be ordered?

A

limb inflammation, isolated blunt/penetrating injury TRO fracture/dislocation and FB respectively
> UL: shoulder, elbow, wrist, hand
> LL: knee, ankle, foot

20
Q

what are the contraindications to ordering XRs at triage?

A

FFH, pregnant, multi-site injury

21
Q

what are the XRs for foot FB (if unanswered in question 12)

A

foot AP/lateral, foot true lateral

22
Q

what are the XRs for throat FB (if unanswered in question 12)

A

neck lateral

23
Q

describe the hip fracture protocol at triage, and how you will assess if patient can be included

A

include if: isolated hip pain post trauma, external rotation and shortening of hip joint
- XR hip and pelvis
- consult Dr for IM/IV tramadol + maxalon if needed

24
Q

what are the inclusion criteria for ‘Direct to Subspecialty: Eye’?

A

c/o ONLY red eye or floaters
referred by OPS
isolation level 0
stable vitals
time: M-F 8am-3pm; sat 8am-11am

25
Q

what are the inclusion criteria for CRAO workflow?

A

sudden unilateral LOV presenting within 4.5h + no ARI

26
Q

what are some examples of P2 uptriage cases?

A

symptomatic ARU
testicular pain/swelling <25yo
brought in on NRM
HI + anticoagulant usage (or unsure)
GPFirst

27
Q

what are some examples of P2 cases?

A

testicular pain/swelling >=25yo
ARU, comfortable
abdominal pain >50yo
chest pain > 25yo
R shoulder/elbow dislocation: to resus
long/deep lacerations
UL: all dislocation/closed #
LL: hip/tibia/fibula/foot closed #

28
Q

in lung auscultation, what are the breath sounds you can anticipate?

A

rhonchi: expiratory
wheeze: expiratory, musical
stridor: inspiratory, harsh
creps: inspiratory, fine/coarse popping/crackles
diminished

29
Q

action if patient has wheeze/rhonchi ONLY

A

MDI salbutamol 6 puffs + PEFR, PAC 1 EDX

30
Q

action if patient has wheeze/rhonchi with creps

A

consult sr dr TRO APO

31
Q

action if patient has creps ONLY

A

CXR

32
Q

action if patient has unilateral diminished/absent breath sounds

A

consult sr dr TRO PTX

33
Q

inclusion and exclusion criteria for paracetamol

A

age 16 and above, pain 6-10 NOT epigastric /T 38 and above
exclude if:
- allergy to paracet
- last admin <6h ago
- cannot swallow (ie. nausea, NGT)

34
Q

inclusion and exclusion criteria for ketorolac

A

age 16-64, pain 6-10 NOT epigastric
exclude if:
- allergy to aspirin, cox-2 inhibitors, NSAIDs, paracetamol
- anticoagulant/steroid use
- asthma, BGIT, cardiac/renal failure
- coagulation disorders (coagulopathy, dengue, thrombocytopenia), cancer, post-hemodialysis

35
Q

inclusion and exclusion criteria for diclofenac

A

age 16-64, pain 6-10 NOT epigastric
exclude if:
- allergy to aspirin, cox-2 inhibitors, NSAIDs, paracetamol
- anticoagulant/steroid use
- asthma, BGIT, cardiac/renal failure
- coagulation disorders (coagulopathy, dengue, thrombocytopenia), cancer, post-hemodialysis
- unable to swallow

36
Q

if patient is allergic to paracetamol, can you give any other analgesia at triage?

A

no

37
Q

signs of airway compromise

A

stridor, swallow impairment + drooling, speech: hot potato, hoarse, unable, swelling of face, neck, tongue, ligatures (encircling/anterior), elevation of tongue, cyanosis, tracheal deviation

38
Q

signs of breathing compromise

A

accessory muscle use, agonal/shallow breathing, breathlessness, cyanosis, distress (tripod + ICS muscle use), desaturation, nasal flaring, pursed lip breathing, unable to speak in full sentences
tachy/brady/apnea

39
Q

signs of circulation compromise

A

active bleeding - hemorrhage/spurters, cold/clammy peripheries, giddiness, pallor, hypotension, tachycardia, diaphoresis

40
Q

signs of disability compromise

A

AMS +/- HI, decreased/loss of consciousness, combativeness, confusion, gcs<12

ED Triage (4 decks)

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