Triage Flashcards
Primary Survey
A
B
C
D
E
Airway
Breathing, Bleeding
Circulation, Consciousness
Disorders
Externa Factors
Description of Class 1, First Priority cases on triage
Treatment must be initiated within seconds. Patient needs immediate care and stabilization.
Class 1: actively dying; catastrophic
Description of Class II, Second priority cases
Critical: Can be actively dying
At risk for rapid decompensation. Must be seen within minutes, limit stress, rapid assessment and doctor should be present to assess patient within minutes.
Description of Class III, Third Priority cases.
Urgent: Patient is stable but at risk for decompensation.
Presenting problem that is non critical.
Initiate treatment within the hour.
Description of Class IV, Fourth Priority Cases
Less urgent: Patient is completely stable. Needs evaluation, but not urgently
To be seen within 12-24 hours.
Description of Class V, Fifth Priority
Non-life threatening.
Patient is fully stable with no underlying comorbidities.
No risk for decompensation.
Can be seen within 24-48 hours without risk.
Morbidity vs Mortality
Morbidity refers to an illness or disease
Mortality refers to death
What are the six perfusion parameters?
Mucous membrane
Capillary refill time
Heart rate
Pulse quality
Extremity temperature
Mentation
What can muffled heart sounds indicate?
- pericardial effusion
- pleural air or fluid
- abdominal organs in chest
Normal
Inspiration:expiration ratio
1:2
What do slow deep breaths indicate?
Upper airway obstruction
dynamic airway collapse
bronchitis
Slow deep breaths minimize resistance
What does increased effort on inspiration indicate?
Laryngeal disease
Extrathoracic tracheal collapse or obstruction
What does increased effort on expiration indicate?
Intrathoracic collapse
lung pathology
What does increased effort on both inspiration and expiration indicate?
mass or foreign body causing airway obstruction
What kind of breathing indicates a restrictive breathing pattern?
What is the pathology?
minimized tidal volume
increased respiratory rate
Indicative of pulmonary parenchymal disease
Stridor
Abnormal high-pitched sound produced by turbulent airflow through the upper airway.
Consistent with upper airway obstruction.
Stertor
Abnormal low pitch sound produced lower in the airway and consistent with partial airway obstruction
What does asynchronous breathing indicate?
plural space pathology
What is kussmaul breathing? What does it indicate?
slower & very deep breathing pattern.
Seen with severe metabolic acidosis and kidney disease.
https://youtu.be/uAnnFscr4LQ
What kind of breathing pattern indicates brain injury or heart failure? Can also be seen with hyponatremia.
Describe the breathing pattern.
Cheyne Stokes
Abnormal breathing is characterized by a gradual increase in breathing, then a decrease. This pattern is followed by a period of apnea.
Can also be seen in dying patients.
https://youtu.be/eAx4fxy7WbA?si=F-WhzFiZ2c8RMbT4
Capillary Refill Time <2 seconds
hyperdynamic state and vasodilation
associated with systemic inflammation, distributive shock, heat stroke/hyperthermia
What does venous distension indicate?
Signs of volume overload.
Right-sided congestive heart failure
Increased right-sided filling pressure.
If patient is in lateral recumbency, raise up limb above the heart and if vein remains distended, it is suggestive of elevated central venous pressure
3 causes of elevated central venous pressure
- volume overload
- pericardial effusion
- Right-sided congestive heart failure
Clinical signs of cardiogenic shock with biventricular failure
pale mucous membranes
prolonged capillary refill time
venous distension
What is pulsus paradoxus and what does it indicate?
Pulse volume appears to decrease during inspiration and becomes normal during expiration.
It can indicate pericardial effusion or tamponade.
What is pulsus alternans and what does it indicate?
Alternating small and large volume pulses.
Commonly seen with left ventricular heart failure.
Pulse deficits
Difference between auscultated heart rate and palpated heart rate.
Significant difference is considered a true emergency
Enteral malnutrition can cause a predisposition to __________ and ___________.
bacterial translocation and secondary sepsis
Scale the levels of consciousness and define (7):
Alert: responds immediately
Disoriented: disorientation in place, impaired memory
lethargic: drowsy but easily rousable with minimal stimulation
Delirium: inability to focus, sustain or shift attention.
Obtunded: Asleep but rousable with stimulation. Cessation of stimulation -> falls back asleep.
Stuporous: Responsive to painful stimuli
Comatose: Unresponsive. Check gag reflex.
AVPU
A: Alert and responsive
V: Responsiveness to verbal stimuli
P: Responsive to painful stimuli
U: unresponsive
Neonates: Thermoregulation
Undeveloped
- lack insulating fat
-shivering reflex
- peripheral vasoconstriction
Last two are not fully developed for at least a week
Mass casualty incident and disaster triage
Acronym: START
Simple Triage and Rapid Treatment
Mass Casualty
Start Method: RAP status
Respiratory
Alertness
Perfusion Status
Mass casualty and Disaster Triage:
SAVE method
Secondary Assessment of Victim Endpoint
Mass casualty and Disaster Triage
SAVE (3 categories)
What is the order of treatment?
Group 1: those that will die regardless of treatment
Group 2: those that will survive regardless of treatment
Group 3: those that will benefit if medical intervention is immediate.
Treatment order: Group 3, then Group 2
Where is the thermoregulatory center located?
Anterior hypothalamus
4 primary mechanisms for heat loss and heat gain. Define each
- Convection: heat transfer between skin and moving air (loss and gain)
- Conduction: heat transfer between skin and objects in contact with skin (loss and gain)
- Radiation: Heat loss or gain to the environment with temperature gradient without direct contact (loss and gain).
- Evaporation: Moisture evaporates into the air pulling heat away from the body (heat only)
Convection
Heat transfer between skin and moving air or water (loss or gain)
Conduction
Heat transfer between skin and objects in contact with skin (loss and gain).
Radiation
Heat loss or gain to the environment along with temperature gradient without direct contact (loss and gain)
Evaporation
Moisture evaporating into the air pulling heat away from the body (heat loss only).
Ophthalmological emergencies
Conditions that if left unattended could result in permanent blindness or loss of an eye.
