Triage concept
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Transcript of Triage concept
TRIAGE To Seive and Sort. To prioritise patient.
BOLEH SAYA
BANTU?
Mak saya tu, demam dah sebulan….
Dah sebulan baru la ni nak
mari..
Aku dah nak pitam ni, tak de yang nak tengok
WHY TRIAGE ? A war happen and a lot of casualties
and patient affected by the war. Problem in actually returning back the
soldier back to the front line to continue involve in war.
French surgeon Baron Dominique Jean Larry first person creating triage.
Triage concept then is to sort who could be treated early and send back to war.
WHY TRIAGE AT ED? Number of patient usually exceed the
capabilities of the emergency department thus we need to prioritise the patient who needs the medical attention first.
If we serve the patient first come first serve then we would not save life but will ended up having multiple casualties.
SO THE CONCEPT IS :prioritizing patients
provide immediate critical care
do the most for the most
Aku tak kena triage
ker?!
OBJECTIVEEnsuring that unstable patients get immediate medical attentionEnsuring that potentially unstable patients receive prompt medical attentionIdentifying patients who require time-related interventions ( pain, poisoning)Ensuring that those who are not likely to deteriorate can wait safely for care (with regular reassessment)
TYPE
• 3 Tier System (International Civil Aviation Organisation)– RED Urgent– YELLOW Semi Urgent– GREEN Non-Urgent
• 5 Tier System ( Manchester Triage Group )– RED Immediate – ORANGE Very Urgent– YELLOW Urgent – GREEN Standard– BLUE Non-Urgent
MALAYSIAN TRIAGE SYSTEMCatego
ryColor code
Condition Emergency action
Priority
1 RED Life @ limb threatening; death if
no intervention. Injuries affecting
ABC
IMMEDIATE
TOP
2 YELLOW Serious but stable injuries; not
immediately life threatening. May
deteriorate without Rx
URGENT SECOND
3 GREEN Non serious, minor stable injuries.
Deferrable
NON URGENT
THIRD
4 BLACK / WHITE
Dead, decapitated, mutilated, severed, apnea, pulse less,
incinerated; unsalvageable
DELAYED LOWEST
PROSES TRIAGE
BILIK MAYAT
BUKU BID
PUTIH
PENDAFTARAN
RESUS
MERAH
PENDAFTARAN
IMMEDIATE CARE
KUNING
BILIK OSCC
BILIK ASTHMA BILIK RAWATAN
LALUAN TERUS
(FAST LANE)
KECEMASAN (G1) KECEMASAN (G2)
RUANG MENUNGGU
BUKAN KECEMASAN
(G3,G4)
TRIAGE SEKUNDER
PENDAFTARAN
HIJAU
TRIAGE PRIMER
IN HOSPITAL TRIAGE1) Primary triage2) Secondary triage3) Surveillance triage
Retriaging patients in waiting area
4) Online triage .5) Definitive Triage.
PRIMARY TRIAGEa) Proactive triage
Outside department Determine the mode of transportation
into dedicated zone
b) Static triage At the counter
PRIMARY TRIAGE Based on power of observation. Base on 5 senses smell, look, touch,
hear,taste. Chief complain and observation will
decide either yellow red or secondary triage.
SECONDARY TRIAGERemember ‘S-O-A-P’ by Larry-Weed Subjective
Patient’s (subject) main complaint(s) and the brief event history
Objective Your (object) physical findings and vital signs
Apply (Assessment) Apply the triage category based on your
assessment Plan
Decide a plan for the patient:1. intervention or treatment2. obtain full set of vital signs3. preliminary diagnostic testing
SECONDARY TRIAGE1) Vital signs assessment
Temp, BP, HR, RR/SPO2 & Pain score
2) First aid Wound dressing / cleaning Immobilization – armsling, rigid immobilizer
3) Simple treatment Pain killer – mild to moderate PCM – watch out for contraindication Tepid sponging
4) ECG / DXT5) Blood investigation
FBC, BUSE UFEME, UPT, X-RAY
SURVEILLANCE TRIAGE Triage di tempat menunggu. Pesakit yang sedang menunggu akan
diperhatikan jika ada perubahan pada kondisi penyakit dan akan di uptriage jika perlu.
DEFINITIVE TRIAGE Triage and Rapid sequence examination done
at the various zone of patient management
Quality Standards of TriageStudy of Triage Error
Categories1. Mild Error
-among non-critical causes G1,G2,G32. Moderate Error
-Between Treatment zones-not affecting patient’s well being
3. Severe Error-Affecting patient’s stability
4. SENTINEL-Severe mistakes causing death, serious morbidity
Quality Standards Targets
1.Sentinel -zero error
2.Severe -<1%
3.Moderate -<5%
4.Mild -<10%
5.Zero Complaint
6.Appreciations
ART and Personality of Triage Core Components
Voice tone–soft & gentle
Correct word & accent Empathy –feeling ,
sensitivity Body language Facial expression Behavioural patterns Sitting position Care
Static (Counter) Triage1) At the Counter
2) To Stand up when talking to Patient (show respect)
3) Appropriate Facial Expression
4) Low Volume Voice
5) Appropriate Behaviour
Challenges in pediatric triage
• Different from adult:a) Anatomy & physiology b) Presentation –
unable to tell symptoms Rely on mother’s history Must see & touch the child –
active running around Weak / lethargy Dehydrated
2 patients – child & the parent
Triage is designedto get the right
patients,to the right place,at the right time,
with the right care provider!
…time is essence!
CONCLUSION Triage adalah pintu kemasukkan pesakit
di jabatan kecemasan. Silap triage maka silaplah management
patient. Image jabatan dilihat di triage, kalau
bagus triage dan pengalaman semasa di triage, biasanya tiada komplain selepas itu.