PEDIATRIC TRIAGE - PdLN

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PEDIATRICTRIAGE

Robin Goodman, MSN, RN, CPENRegistered Nurse LeadPediatric Liaison Nurse

Children’s Hospital Los Angeles

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INCREASES VISITSMEDICAL HOME LENGTH OF STAY

EMERGENCY VISITS

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Right patient, right place, right level of care

Triage

SPOT CHECK COMPREHENSIVETRAFFIC DIRECTOR

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HIGH RISK (RED FLAGS)

DANGER ZONE VITALS

LIFE THREATENING (PAT)

RESOURCES

ESI TRIAGE

Emergency Severity Index (ESI): A Triage Tool for Emergency Department. Content last reviewed February 2013. Agency for Healthcare Research and

Quality, Rockville, MD.

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3

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ACUITY RATINGS

NON-URGENTCRITICAL URGENT

1 3 5

EMERGENT SEMI-URGENT

2 4

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CRITICAL

LEVEL 1 TRAUMA CRITERIA

IMMEDIATE PROVIDER INVOLVEMENT REQUIRED

PATIENT DYING/REQUIRES CRITICAL INTERVENTION

1

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EMERGENT

CONFUSED/LETHARGIC/DISORIENTED

BEHAVIORAL HEALTH CONSIDERATIONS

HIGH-RISK SITUATION

2 SEVERE PAIN >7/10 (CONSIDER)

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URGENT

CAN WAIT A PERIOD OF TIME

2+ RESOURCE ALLOCATION

3

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SEMI-URGENT

CAN WAIT EXTENDED PERIOD OF TIME

1 RESOURCE ANTICIPATED

4

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NON-URGENT

REQUIRES MSE

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U N D E RSTA N D I N G R ES O U RC ES

Resources Not Resources

Laboratory (blood, urine, CSF, etc.) History & physical (including

pelvic, eye, & ear exams)

ECG

X-rays

CT-MRI-ultrasound angiography

Point-of-care testing

IV fluids (hydration) Saline or heplock

IV, IM or nebulized medications PO/PR/GT/JT medications

Tetanus immunization

Prescription refills

Specialty consultation (MSW) Phone call to PCP

Simple procedure = 1simple lac repair, splint formation/casting

Complex procedure = 2 moderate sedation, chest tube, LP

Simple wound care (dressings,

rechecks)

Crutches, pre-formed splints,

Cast check

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HYPO/HYPERTHERMIA

FEVER?

PEDIATRIC PATIENTS HAVE THEM

VITAL SIGNS

NOT PROVIDER SPECIFIC

ASSIGN ACUITY/DISPOSITION

ASSESSMENT

ABCDE

PAT

ACROSS-THE-ROOM ASSESSMENT

PAST MEDICAL HISTORY

HISTORY OF ILLNESS/INJURY

PERTINENT HISTORY

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STANDARDIZED APPROACH

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• VENTILATION

• PERFUSION

• VENTILATION/PERFUSION

• SICK, SICKER,SICKEST

ACROSS THE ROOM ASSESSMENT

PEDIATRIC ASSESSMENT TRIANGLE

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ORTHOMETABOLIC ENVIRONMENTAL

NEURORESPIRATORY CIRCULATORY GI/GU

RED FLAGS

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COMPONENT 2

ASSESSMENT

ABCDE

+

FOCUS

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COMPONENT 3

HISTORY

PA ST M E D I C A L HI STO RY

+

HI STO RY I L L N ES S / I N J U RY

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COMPONENT 4

VITAL SIGNS

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Excessive Tachycardia Table

Children’s Hospital Association

Temp 38C100F

38.3C101F

38.8C102F

39.4C103F

40C104F

40.5C105F

41.1C106FHR for

Age

<2YR >180 >185 >190 >195 >200 >205 >210

2-5

YR >140 145 150 155 160 165 170

6-12

YR >130 135 140 145 150 155 160

13-18

YR >110 115 120 125 130 135 140

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Minimal Acceptable Systolic BP in Children

Term neonate

60 mmHg SBP

1 – 12 months

70 mmHg SBP

1 – 10 years

70 + 2x age in years SBP

> 10 years

90 mmHg SBP

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COMPONENT 5

TEMPERATURE

U N D E R 2 8 DAYS

I M M U N O S U P R ES S E D

F U O

I M M U N I ZAT I O N STAT U S

Age-Temperature ESI level

• 1 - 28 days Fever over 100.4° F (38.0° C) Level 2

• 1 - 3 months Fever over 100.4° F (38.0° C) Consider 2

• 3 - 36 months Fever over 102.2° F (39.0° C) Consider 3• If incomplete immunizations, no obvious source of

infection

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COMPONENT 6

PAIN

VA L I DAT E D PA I N S C A L E

N O N - P H A R M A C O L O G I C A L I N T E R V E N T I O N S

P H A R M A C O L O G I C A L I N T E R V E N T I O N S

FA M I LY S U P P O R T

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AIRWAY BREATHINGGENERAL

NEURO EXPOSURECIRCULATION

PEDIATRIC CONSIDERATIONS

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APPROACH FAMILY CENTERED CAREEDUCATION

SAFETY RESOURCESEQUIPMENT

PEDIATRIC CONSIDERATIONS

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CASE EXAMPLES

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Key

Take Home

Points

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THANK YOU

ANY QUESTIONS