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Name questions to ask for purposes of triage
- ABC’s
- General appearance
- What are the S/S
- Length of S/S
- Age
- History of present illness, travel?
- Or anyone that has traveled?
- anyone at home ill?
- Any kids at home that go to daycare
- Pain – PQRST
- V/S
- H&P - surgeries
- Medications
- Allergies
- LMP
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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?
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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
- anaphylaxis
- flaccid baby
- hypoglycemia with change in mental status
- unresponsive with strong odor of ETOH
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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
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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
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What are considered resources for ESI ranking?
- Labs
- ECG
- XR, CT, MRI, U/S
- angiography
- IV fluids
- IV, IM, nebulized meds
- Specialty consult
- simple procedure: laceration, foley cath
- complex procedure: conscious sedation
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What are NOT considered resources for ESI ranking?
- BS (point of care testing)
- saline or heplock IV
- PO meds
- immunizations
- prescription refills
- phone call to PCP
- simple wound care
- crutches, splints, slings
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Quick way to think of Level 1 ESI
Requires immediate life-saving intervention
-
Quick way to think of level 2 ESI?
- High risk situation
- OR
- confused/lethargic/disoriented
- OR
- severe pain/distress
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What will guide treatment in overdose?
- ABC’s - continue to monitor
- IV
- ECG
- antidote
- lab work - tox screen, pregnancy test, LFT's, renal
- psych consult (72H hold)
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antidote for acetaminophen?
mucomyst in liquid
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antidote for Digoxin?
digibind
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antidote for benzodiazepines?
flumazenil (Romazicon)
-
antidote for narcotics?
Narcan
0.2mg VERY slow to prevent aggression or seizing
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antidote for heparin?
protamine sulfate - only if massively bleeding
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antidote for Coumadin?
Vitamin K
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What will the EKG look like in Pericarditis?
All leads will show PR depression and ST segment elevation
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