Triage and ABCD
Dr Colin Gilhooley
Objectives
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What is triage?
Why should you do triage?
When should you do triage?
Who should do triage?
Where should you do triage?
Objectives
•
•
•
•
•
What is triage?
Why should you do triage?
When should you do triage?
Who should do triage?
Where should you do triage?
• HOW SHOULD WE TRIAGE?
What is triage?
What is triage?
• from the French verb trier, meaning to
separate, sift or select.
• Rapid sorting of patients to identify those who
are critically ill.
• Then to provide effective life saving care.
Why triage?
Why triage?
• Many deaths in hospital occur within 24 hours of
admission.
• Some can be prevented if identified on arrival &
treatment started without delay.
• Children not checked before a senior health
worker examines them.
• So wait a very long time before seen and treated.
• Children die of treatable conditions when waiting
in the queue for their “turn”.
When triage?
When triage
• When they walk through the door
• Every patient
• Reassess if there appears to be any change in
condition
Who should triage?
Who should triage?
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Doctors
Nurses
Clinical officers
Pharmacists
Students
Cleaners
Security personnel
• Parents
Who should triage?
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Doctors
Nurses
Clinical officers
pharmacists
Students
Cleaners
Security personnel
EVERYONE
(as long as they are trained)
Where should we triage?
Where should we triage?
• Needs to be done in the waiting area
• It can be done anywhere
Problems
• 1. No one knows how to do
• 2. There is no time to do it
• 3. There is no where to do it
• 4. Even if we do it what next?
Problems
• 1. No one knows how to do
– Training
• 2. There is no time to do it
• 3. There is no where to do it
• 4. Even if we do it what next?
Problems
• 1. No one knows how to do
– Training
• 2. There is no time to do it
– It takes seconds on average
• 3. There is no where to do it
• 4. Even if we do it what next?
Problems
• 1. No one knows how to do
– Training
• 2. There is no time to do it
– It takes seconds on average
• 3. There is no where to do it
– The waiting area is the perfect place
• 4. Even if we do it what next?
Problems
• 1. No one knows how to do
– Training
• 2. There is no time to do it
– It takes seconds on average
• 3. There is no where to do it
– The waiting area is the perfect place
• 4. Even if we do it what next?
– Training on ABCD
Summary
• What is triage?
• Why should you do triage?
• When should you do triage?
• Who should do triage?
• Where should you do triage?
Summary
• What is triage?
Rapid Assessment
• When should you do triage?
As patient arrives
• Where should you do triage? The waiting area
• Who should do triage?
Anyone trained
• Why should you do triage?
It saves lives
How to triage
How to triage
•E
•P
•Q
How to triage
• Emergency
•P
•Q
How to triage
• Emergency
• Priority
•Q
How to triage
• Emergency
• Priority
• Queue (non-urgent)
Emergency
Emergency – what are the signs
Emergency – The Signs
• Central cyanosis
• Severe respiratory
distress
• Obstructed
breathing
• Shock
• Severe
dehydration with
diarrhoea
• Decreased level of
consciousness
• Convulsions
Emergency – What next
• Oxygen
• ABCD
Priority
Who is a priority
3 TPR - MOB
Who is a priority?
• Tiny baby
– any sick child aged under two months
• Temperature
– Hot to touch – check temp with thermometer
– Consider antipyretics and BS
• Trauma or other urgent surgical condition
– Acute abdomen, fractures, head injuries
Who is a priority?
• Pallor (severe)
– comparing the child’s palms with your own
• Poisoning
• Pain (severe)
– Unusually and should be investigated
Who is a priority?
• Respiratory distress
– Severe chest indrawing and tachypnoea
• Restless, continuously irritable, or lethargic
– Fails to settle to parental comfort
• Referral (urgent)
Who is a priority?
• Malnutrition: Visible severe wasting
• Oedema of both feet
• Burns
Queue
Everyone else
Summary
• Emergency
• Priority
• Queue (non-urgent)
Summary
• Emergency
– life threatening within minutes to 1hour
• Priority
– life threatening within hours
• Queue (non-urgent)
– unlikely to be life threatening
Summary
• What is triage?
Rapid Assessment
• Where should you do triage? The waiting area
• When should you do triage?
As patient arrives
• Who should do triage?
Anyone trained
• Why should you do triage?
It saves lives
Summary
• How do we triage?
–E
–P
–Q
What do we do after triage?
What do we do next?
• Airway
• Breathing
• Circulation, Convulsions and Coma
• Dehydration
Case Study
• A nine-month old baby boy is carried into the
children’s section of the outpatient
department in his mother’s arms.
• He appears to be asleep.
• At the triage desk he is seen by a nurse and
found to have lips and tongue that are
grey/blue in colour.
• A nine-month old baby boy is carried into the
children’s section of the outpatient
department in his mother’s arms.
• He appears to be asleep.
• At the triage desk he is seen by a nurse and
found to have lips and tongue that are
grey/blue in colour.
• He is taken straight into the resuscitation
room as an emergency and given oxygen.
• He is noted to be grunting and breathing very
fast.
• His hands are cold to touch and the capillary
refill time is prolonged to four seconds.
• He is taken straight into the resuscitation
room as an emergency and given oxygen.
• He is noted to be grunting and breathing fast.
• His hands are cold to touch and the capillary
refill time is prolonged to four seconds.
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An intravenous cannula is placed.
A blood sample is taken at the same time.
A bolus of 10% glucose 5mls/kg is given
An intravenous infusion of normal saline is
commenced at 20ml/kg to run as fast as it can
go.
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An intravenous cannula is placed.
A blood sample is taken at the same time.
A bolus of 10% glucose 5mls/kg is given
An intravenous infusion of normal saline is
commenced at 20ml/kg to run as fast as it can
go.
• Other treatments are given, depending on the
result of the investigations and the response
to the treatment he receives.
• It is now 18 minutes since the baby came
through the outpatient department’s door,
and his situation is stable.
• It is now time to take a full history and carry
out a full examination to make a definitive
diagnosis.
It is possible for this to happen in
THIS hospital.
Questions
Objectives
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What is triage?
Why should you do triage?
When should you do triage?
Who should do triage?
Where should you do triage?
How to Triage Emergency/Priority 3TPR MOB
Introduced ABCD