Name questions to ask for purposes of triage
- General appearance
- What are the S/S
- Length of S/S
- History of present illness, travel?
- Or anyone that has traveled?
- anyone at home ill?
- Any kids at home that go to daycare
- Pain – PQRST
- H&P - surgeries
What are the things that determine levels on ESI (emergency severity index)?
- Is this patient dying?
- Is this a patient who shouldn't wait?
- How many resources will this patient need?
- What are the patient's vital signs?
Name some things that would make a person ESI Level 1
- cardiac/respiratory arrest
- severe respiratory distress
- SpO2 <90
- critically injured trauma pt that is unresponsive
- OD with respiratory rate of 6
- sever bradycardia or tachycardia with signs of hypoperfusion
- chest pain, pale, diaphoretic, BP 70/palp
- weak/dizzy, RH = 30
- flaccid baby
- hypoglycemia with change in mental status
- unresponsive with strong odor of ETOH
Name some things that would make a person ESI Level 2
- High-risk situations:
- active CP, coronary syndrome but stable
- needle stick in health care worker
- signs of stroke but doesn't meet level-1 criteria
- chemo with a fever
- suicidal or homicidal pt
- confusion, lethargic, disoriented
- severe pain or distress
What determines if a patient goes into ESI level 3, 4, or 5?
How many resources are needed
- Level 3: 2 or more
- Level 4: 1
- Level 5: 0
What are considered resources for ESI ranking?
- XR, CT, MRI, U/S
- IV fluids
- IV, IM, nebulized meds
- Specialty consult
- simple procedure: laceration, foley cath
- complex procedure: conscious sedation
What are NOT considered resources for ESI ranking?
- BS (point of care testing)
- saline or heplock IV
- PO meds
- prescription refills
- phone call to PCP
- simple wound care
- crutches, splints, slings
Quick way to think of Level 1 ESI
Requires immediate life-saving intervention
Quick way to think of level 2 ESI?
- High risk situation
- severe pain/distress
What will guide treatment in overdose?
- ABC’s - continue to monitor
- lab work - tox screen, pregnancy test, LFT's, renal
- psych consult (72H hold)
antidote for acetaminophen?
mucomyst in liquid
antidote for Digoxin?
antidote for benzodiazepines?
antidote for narcotics?
0.2mg VERY slow to prevent aggression or seizing
antidote for heparin?
protamine sulfate - only if massively bleeding
antidote for Coumadin?
What will the EKG look like in Pericarditis?
All leads will show PR depression and ST segment elevation