Emergency department

1
Emergency department

• Triage

2
TRIAGE
????????????????

• ??????????????????????????????????????????????????
  ???????????????????? ???????????????????
• ???????????????????????????????
  ???????????????????????????(Life-Threatening)
  ??????????????????????????????????????????????????
  ??????????????????????????????????????????????????
  
• 5 R Right patient
• Right time
• Right place
• Right care
• Right provider

3
Triage processJob description of triage nurse

• 1.Triage Decision

• 2.Initial Treatment or InterventionInformation

• ??????????????????????????????????????????????????
  ??
• ??????????????????????????????????????????????????
  (Appropriate Area)

• ????????????????????????????????????????????
• ????????????????????????????????????
  ?????????????????? ???????????????????????????????
  ???? ????
• o ????????????????????????
• o ????????
• o ???????????? ????????????????
• ???????????????????????????? ???????

4
Triage decision making
5
AYTS - AYUTTHAYA TRIAGE SYSTEM
ATS AUSTRALIAN TRIAGE SYSTEM

• A- airway
• B- breathing
• C- circulation
• D- disability

ESI EMERGENCY SEVERITY INDEX V.4

• ?????????
• ?????????
• ???????????????????????? ?

6
5 levels triage
7
Decission point
?????????? ?????????
patient
1
Triage nurse ??????? 1.GA primary
survey 2.Vital sign sat O2 3.Chife
complain 4.Identify risk factor 5.Identify
resource needs
yes
2
yes
3
?????????????
yes
????????????? ?????????????????????
4
yes
5
yes
8
????? 1 Life threatening condition
??????????????????????????????????
?????????????????? ( ????????????? 0 ???? )
9
Life-saving intervention

• Airway/breathing
• BVM ventilation
• Intubation
• Surgical airway
• Emergent cardioversion
• External pacing
• Procedures
• Chest needle decompression
• Pericardiocentesis

• Hemodynamics
• Significant IV fluid resuscitation
• Medications
• Naloxone
• D50
• Dopamine
• Atropine
• Adrenaline

10
Decission point
patient
1
Triage nurse ??????? 1.GA primary
survey 2.Vital sign sat O2 3.Chife
complain 4.Identify risk factor 5.Identify
resource needs
yes
2
yes
3
?????????????
yes
4
yes
5
yes
11
????? 2 Emergency condition?????????????????????
????????????????????????????????
(???????????????????? 15 ???? )
A ???????????????????????????????? ( upper airway obstruction ) ???? ?? stridor ???? drooling POTENTIAL LIFE LIMB ORGAN THREATENING
B ???????????????????????????????????????? ( severe respiratory distress ) ????????? gt 30 ?????/???? Sat O2 lt 95 ??????????? accessory muscle ?????? chest wall retraction POTENTIAL LIFE LIMB ORGAN THREATENING
C ?????????????????????????????????? ?????? ???? capillary refill gt 2 ?????? ????? lt 50 ?????/???? ???? ????? gt 150 ?????/???? ????????? ????????????( gt 750 cc ) POTENTIAL LIFE LIMB ORGAN THREATENING
D Glassglow coma score lt 13 POTENTIAL LIFE LIMB ORGAN THREATENING
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POTENTIAL LIFE LIMB ORGAN THREATENING ?????????????????????????????????????????? ??????????????????????????( pain score gt 7 ) ????????? vital signs ??????? ????????????????????????? DTX lt 60 mg ???? DTX lt 80 mg ?????????????? ???????????????????????? ????????? ???? ????????? ?????? gt 39 oc ????????????? 6 ?? ???? gt 40 oc ????????? ??????? body temp.lt 36 oc ?????????????????????????????? ??????????????????????????????????????? ????????????????? ?????????????? 2 ?????????? ????????????????? ???????????????????????? ???? ???????? ????????????????? ???????????????????????? ???? ????????????? ???????????????????????????????? ????????????? ???????????????????????????? ????????????????????????????????????????????????????
13
????? 2 Emergency condition

• ????????????????????????????????? ???????? vital
  signs ?????? danger zone ??????? ????? 2
• ????????????? OPD ?????????????
• ??????????

14
Decission point
patient
1
Triage nurse ??????? 1.GA primary
survey 2.Vital sign sat O2 3.Chife
complain 4.Identify risk factor 5.Identify
resource needs
yes
2
yes
3
yes
????????????? ?????????????????????
4
yes
5
yes
15
High risk situation High risk situation High risk situation High risk situation
age Co- mobid MECHANISM OF INJURY ??????????????????
gt 65 ?? DM,HT ???????? gt 30 ???? ???
lt 3 ????? IHD ?????? ???? ?????? ????????? ??????????????
ASTHMA/COPD ?????????????? ? ??????????? ??????????
CKD ??????????????? ?????????????? ??? ???? alteration of conscious
MALIGNANCY Burn ??????????
CIRRHOSIS Electrical injury
IMMUNOCOM PROMISE ??????????? gt 6 ???? ???????????????????????????????????
Child abuse
????????????
16
(No Transcript)
17
Expect resources need
18
????? 3 Urgency condition???????????????????????
??????????????????????????????????????????????????
????? ?????? (???????????????????? 30 ????)

•  ???????????????
• SBP gt 180 mm.Hg
• DBP gt 100 mm.Hg
• BP gt 160/90 mm.Hg ??????????????
• ???????????????? ( gt 500 cc )
• ???????????????????????? ???? ???????????
• ?????????? ?????????????? ???????????
• ??? ???????????????????????????? ????
  ????????????? ???? ?????????????????? ???? ???
  ????????????????? SIRS (sepsis)
• ??????????????????
• ????????????????????????????? ( moderate
  dehydration)
• ??????????????? ??????????????????????
  ?????????????????
•  

• ?????????????????????????????????? ????
  ????????????????? ???????????
• ???????????????? ( pain score gt 5 ) ?????????
  vital sign ???????
• ??????????????????????????????????????????????????
  ??
• ?????????????????????????????
• ??????????? 65 ?? ???????????? 5 ??
• ???????????????????? ???? rupture AAA ????
  ectopic pregnancy
• ??????????????????????? ?????????????
  ????????????? /????????????
• ???????????????????????????????????
  ??????????????????
• ????????????????????????????????????????????????
• ??????????????????????? 3 ?????

19
????? 4 Less urgency condition??????????????????
???????? (???????????????????? 60 ???? )

• ????????????????? ( lt 500 cc )
• ?????????????? ?????????????????????
  ????????????????????????
• ???????????????????????????????????? ????
  ??????????
• ???????????????????????????????????????
• ????????????????????????????????????????? ????
  ?????????????????
• ????????????????( 5 gt pain score gt 3 )
• ?????????????? ??????????????????????????????

• ???????????????????? ???? ????????????????
  ?????????????????????? ??????????????????
• ??????????????????????????????????????
  compartment syndrome
• ???????????????
• ???????????????????????????????????????
  ?????????????????????????
• ??????????????????????????????????
  ??????????????????????? ??????????????????????????
  ????????

20
????? 5 Nonurgency condition????????????????????
?? ( ???????????????????? 120 ???? )

• ??????????? ( pain score lt 3 ) ???????????????????
  ?????
• ????????????????????? ????????????????
  ??????????????????????????????
• ????????????????? ?????????????? ???????????
• ?????????? ???? ????? ???? ?????????
• ????????????????????????? ??????????????????????

21
Hospital triage
22
OPD or ER ?
ER
OPD
????????????????? ????? 24 ?????????? ER