triage

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Excellent presentation. May I download it???? Steven Oxler, MD, FACEP

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Presentation Transcript

TRIAGE : 

TRIAGE

Topics : 

Topics

What is Triage? : 

What is Triage? “Triage” means “to sort” Looks at medical needs and urgency of each individual patient Sorting based on limited data acquisition Also must consider resource availability

“The needs of the many outweigh the needs of the few or the one." : 

“The needs of the many outweigh the needs of the few or the one." Star Trek

Triage is a dynamic process and is usually done more than once. : 

Triage is a dynamic process and is usually done more than once.

Slide 7: 

Primary Triage Secondary Triage Tertiary Triage “Continuous Integrated Triage”

Primary Disaster Triage : 

Primary Disaster Triage Goal: to sort patients based on probable needs for immediate care. Also to recognize futility. Triage based on physiology

Secondary Disaster Triage : 

Secondary Disaster Triage Incorporates: A reassessment of physiology An assessment of physical injuries Initial treatment and assessment of patient response Further knowledge of resource availability

Secondary Triage Tools : 

Secondary Triage Tools Goal is to distinguish between: Victims needing life-saving treatment that can only be provided in a hospital setting. Victims needing life-saving treatment initially available on scene. Victims with moderate non-life-threatening injuries, at risk for delayed complications. Victims with minor injuries.

Tertiary Disaster Triage : 

Tertiary Disaster Triage Goal: to optimize individual outcome Incorporates: Sophisticated assessment and treatment Further assessment of available medical resources Determination of best venue for definitive care

MCI Triage: Key Points : 

MCI Triage: Key Points Resources and patient numbers and acuity are limiting factors. Must be dynamic, responsive to changes in both resources and patient needs.

Triage Categories : 

Triage Categories

Triage Categories : 

Triage Categories Red: Life-threatening but treatable injuries requiring rapid medical attention Yellow: Potentially serious injuries, but are stable enough to wait a short while for medical treatment

Triage Categories : 

Triage Categories Green: Minor injuries that can wait for longer periods of time for treatment Dead or still with life signs but injuries are incompatible with survival in austere conditions Black:

Triage Tools : 

Triage Tools

Basic Disaster Life Support : 

Basic Disaster Life Support MASS Triage Move Assess Sort Send

SALT Triage : 

SALT Triage Sort Assess Life-saving Interventions Treatment/Transport

START : 

START Simple Triage And Rapid Treatment

START : 

START Used for Primary Triage Used on-scene and at hospitals Recommended for patients > 100 lbs

START : 

START First - clear the walking wounded using verbal instructions. Direct them to the treatment areas for detailed assessment and treatment and Tag These as MINOR Now check your RPMs

START : 

START RPM Respiration’s None - Open the Airway Still None? - DECEASED Restored?- IMMEDIATE Present? Above 30 - IMMEDIATE Below 30 – CHECK PERFUSION

RPM : 

RPM PERFUSION Radial Pulse Absent or Capillary Refill > 2 secs IMMEDIATE Radial Pulse Present or Capillary Refill < 2 secs CHECK MENTAL STATUS

RPM : 

RPM Mental Status Can Not Follow Simple Commands (Unconscious or Altered LOC) IMMEDIATE Can Follow Simple Commands DELAYED

START Triage : 

START Triage RESPIRATIONS NO YES Dead or Expectant Immediate Position Airway NO YES Over 30/min Immediate Under 30/min PERFUSION Cap refill > 2 sec Control Bleeding Immediate Cap refill < 2 sec. MENTAL STATUS Failure to follow simple commands Can follow simple commands Immediate Delayed

START: Step 1 : 

START: Step 1 Triage officer announces that all patients that can walk should get up and walk to a designated area for eventual secondary triage. All ambulatory patients are initially tagged as Green.

START: Step 2 : 

START: Step 2 Triage officer assesses patients in the order in which they are encountered Assess for presence or absence of spontaneous respirations If breathing, move to Step 3 If apneic, open airway If patient remains apneic, tag as Black If patient starts breathing, tag as Red

START: Step 3 : 

START: Step 3 Assess respiratory rate If ≤30, proceed to Step 4 If  30, tag patient as Red

START: Step 4 : 

START: Step 4 Assess capillary refill If ≤ 2 seconds, move to Step 5 If  2 seconds, tag as Red

START: Step 5 : 

START: Step 5 Assess mental status If able to obey commands, tag as Yellow If unable to obey commands, tag as Red

Mnemonic : 

Mnemonic R P M 30 2 Can do

What age? : 

What age?

Secondary Triage : 

Secondary Triage All green patients must be individually assessed in secondary triage. Assess physiology Assess injuries Assess probability of deterioration Assess needs vs. resource availability

Secondary Triage : 

Secondary Triage Some children may be carried to the green area by others. They have not proven their physiologic stability by performing the complex act of walking. These children should be assessed first among all those in the green area.

Slide 35: 

Position the upper airway of the apneic child. If they start to breathe, tag them as

Slide 36: 

If the child doesn’t start breathing with upper airway opening, feel for a pulse. If no pulse is palpable, tag the patient as

Slide 37: 

If the patient has a palpable pulse, give 5 mouth-to-barrier breaths to open the lower airways. Tag as below, depending on response to ventilations. DO NOT CONTINUE TO VENTILATE THE PATIENT. RESUME TRIAGE DUTIES.

Multiple Casualty Exercise : 

Multiple Casualty Exercise Patient states he can’t move or feel his legs Respirations are 26 Pulse is 110 (Radial) He is awake and oriented What Triage Category?

Multiple Casualty Exercise : 

Multiple Casualty Exercise Patient states he can’t move or feel his legs Respirations are 26 Pulse is 110 (Radial) He is awake and oriented What Triage Category?

Slide 40: 

Patient is soaked with blood no obvious killer bleed Respirations are 38 Pulse is weak, no radial He is awake What Triage Category?

Slide 41: 

Patient is soaked with blood no obvious killer bleed Respirations are 38 Pulse is weak, no radial He is awake What Triage Category?

Slide 42: 

Patient walks over to you and has an obvious broken arm Respirations are 22 Pulse is 124 (Radial) He is awake, alert, and crying What Triage Category?

Slide 43: 

Patient walks over to you and has an obvious broken arm Respirations are 22 Pulse is 124 (Radial) He is awake, alert, and crying What Triage Category?

Slide 44: 

Patient is face down in the field Not Breathing Weak Carotid Pulse She is unresponsive What do you do first?

Slide 45: 

Patient is face down in the field Not Breathing Weak Carotid Pulse She is unresponsive What do you do first? OPEN THE AIRWAY

Slide 46: 

Patient gurgles but can’t maintain an open airway and Is not breathing Weak Carotid Pulse She is unresponsive What Triage Category?

Slide 47: 

Patient gurgles but can’t maintain an open airway and Is not breathing Weak Carotid Pulse She is unresponsive What Triage Category?

Slide 48: 

Triage should be done with the head, not the heart.