Title: Emergency department
1Emergency department
2TRIAGE
????????????????
- ??????????????????????????????????????????????????
???????????????????? ??????????????????? - ???????????????????????????????
???????????????????????????(Life-Threatening)
??????????????????????????????????????????????????
??????????????????????????????????????????????????
- 5 R Right patient
- Right time
- Right place
- Right care
- Right provider
3Triage processJob description of triage nurse
- 2.Initial Treatment or InterventionInformation
- ??????????????????????????????????????????????????
?? - ??????????????????????????????????????????????????
(Appropriate Area)
- ????????????????????????????????????????????
- ????????????????????????????????????
?????????????????? ???????????????????????????????
???? ???? - o ????????????????????????
- o ????????
- o ???????????? ????????????????
- ???????????????????????????? ???????
4Triage decision making
5AYTS - AYUTTHAYA TRIAGE SYSTEM
ATS AUSTRALIAN TRIAGE SYSTEM
- A- airway
- B- breathing
- C- circulation
- D- disability
ESI EMERGENCY SEVERITY INDEX V.4
- ?????????
- ?????????
- ???????????????????????? ?
65 levels triage
7Decission 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 ???? )
9Life-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
10Decission 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
12 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 ?????????????
- ??????????
14Decission 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
15High 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)
17Expect 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 ) ???????????????????
????? - ????????????????????? ????????????????
?????????????????????????????? - ????????????????? ?????????????? ???????????
- ?????????? ???? ????? ???? ?????????
- ????????????????????????? ??????????????????????
21Hospital triage
22OPD or ER ?
ER
OPD
????????????????? ????? 24 ?????????? ER