10. ETAT.pptx

emergency triage and treatment

1. ETAT Emergency Triage Assessment & Treatment

2. ETAT Emergency Triage Assessment and Treatment Aims to reduce the number of children dying in the first 24 hours of admission to hospital

3. Course Objectives At the end of the course you will be able to: Triage all sick children when they arrive at a health facility into the following categories: Those with emergency signs Those with priority signs Those who are non-urgent cases Assess a child’s airway and breathing and give emergency treatment Assess the child’s status of circulation and level of consciousness Manage shock, coma and convulsions in a child Assess and manage severe dehydration Save Lives!

4. Triage and the ABCD concept Module One

5. Module One -Objectives After this module you will be able to: Understand the principles of triage and the ABCD approach Triage all sick children when they arrive at a health facility into the following categories: Those with emergency signs Those with priority signs Those who are non-urgent cases

6. What is Triage? Triage is the sorting of patients into priority groups according to their need and the resources available The aim of triage is to identify very sick children quickly so they may be treated without delay Many children die within the first 24 hours of admission to hospital and many of these deaths are preventable. Triage aims to reduce these unnecessary deaths.

7. Triage Categories All sick children are rapidly examined on arrival and sorted into 3 categories: EMERGENCY signs – who require immediate emergency treatment PRIORITY signs – who should be given priority in the queue, rapidly assessed and treated without delay NON-URGENT cases – who can wait their turn in the queue. The majority of children seen will be non-urgent cases.

8. Triage Process How long does it take? Not long! Experienced staff can triage in 20 seconds When does it happen? As soon as the child arrives in hospital Where does it take place? Anywhere children are first seen – under 5 clinic, emergency room, ward Emergency treatment area should be close by but some treatments can be started anywhere Who should triage? All staff involved in care of sick children should be able to triage and ideally be able to give emergency treatment Non-medical staff who may meet children on arrival should also be trained in basic triage

9. How to triage Assess for each group of emergency signs in turn: ABC(3)D As soon as an emergency sign is found emergency treatment must be started Do not wait to assess other ‘E’ signs before starting treatment Once treatment is given continue to look for other ‘E’ signs If no ‘E’ signs are found move on to Priority signs If ‘P’ signs are found child must be given priority for full assessment and treatment If no ‘E’ or ‘P’ signs are found child is a non-urgent case and should be directed to queue

10. Emergency Signs – ABCD Triage involves looking for signs of serious illness or injury Emergency signs are sorted in order of priority as: A = Airway B = Breathing C = Circulation, Coma, Convulsions D = Dehydration

11. Airway or Breathing Problems To assess for airway or breathing problems you need to know: Is the child breathing? Is the airway obstructed? Is the child blue (centrally cyanosed)? Does the child have severe respiratory distress? Look, listen and feel for breathing Listen for sounds of obstruction (noisy breathing) Look for severe chest in drawing, accessory muscle use, very fast breathing Is the child too breathless to talk or feed?

12. !E Sign! If any ‘E’ signs of airway or breathing problems are found child is classed as ‘E’ or P1 and should be taken immediately for appropriate emergency treatment.

13. Circulation To assess for circulation problems you need to know: Does the child have warm hands? If yes move on to assess for coma If not, is the capillary refill time longer than 3 secs? Is the pulse weak and fast?

14. ! E Sign ! If any ‘E’ signs of circulation problem are found child is triaged as ‘E’ or P1 and should be taken immediately for appropriate emergency treatment

15. Coma and convulsions To assess for coma make a rapid assessment of conscious level: A = ALERT V = responds to VOICE P = responds to PAIN U = UNRESPONSIVE A child who responds only to pain or is unresponsive is classed as coma Look for repetitive, abnormal movements or twitching (signs of convulsion)

16. ! E Signs ! If any ‘E’ signs of coma or convulsions are found the child is classed as ‘E’ or P1 and should be taken immediately for appropriate medical treatment

17. Dehydration To assess for severe dehydration you need to know: If the child is lethargic or unconscious If the child has sunken eyes If the skin pinch goes back slowly

18. ! E Signs ! If any ‘E’ sign of dehydration is found the child is classed as ‘E’ or P1 and should be taken immediately for emergency treatment

19. ABCD Emergency Signs If the child has any sign of the ABCD it means the child has an emergency ‘E’ sign and emergency treatment should start immediately When ABCD has been completed and there are no emergency signs, continue to assess Priority signs

20. Priority Signs These children need prompt, but not emergency, assessment and treatment These signs can be remembered with the symbols: 3 (TPR )MOB

21. Priority signs – 3 (TPR )MOB Tiny baby Temperature Trauma Pallor Poisoning Pain Restless Respiratory distress Referral Malnutrition/ marasmus Oedema Burns

22. Priority signs 3 (TPR)MOB Tiny baby – any sick baby under 2 months Small babies difficult to assess, more prone to infection, more likely to deteriorate quickly Temperature: child is very hot High fever may need prompt treatment and investigation eg . Paracetamol Trauma or other urgent surgical condition Includes acute abdomen, fractures, head injury

23. Priority signs 3 (TPR)MOB Pallor Severe pallor may indicate severe anaemia needing urgent transfusion Poisoning Child with history of swallowing drugs or poisons may deteriorate rapidly and may need specific urgent treatment Pain Severe pain requires early full assessment and pain relief

24. Priority Signs – 3 (TPR) MOB Restless, lethargy, irritable Child who is conscious but cries constantly and will not settle. May have serious illness such as meningitis Respiratory distress Moderate respiratory distress (indrawing or difficulty breathing that is not severe) requires urgent but not emergency treatment. If in doubt class as ‘E’ Referral Any urgent referral from another hospital or clinic should be seen as a priority

25. Priority Signs – 3 (TPR)MOB Malnutrition/ marasmus Severe wasting may indicate severe malnutrition ( marasmus) Oedema Oedema of both feet may indicate another form of severe malnutrition, Kwashiorkor Burn Major burns are very painful and children can deteriorate rapidly

26. Non-urgent Once assessment is complete if no emergency or priority signs are found the child is classed ‘non-urgent’ and should wait their turn in the queue However if there is any change in the child’s condition the child will need to be triaged again and treated appropriately

27. Treatment Emergency management Treatment must be started as soon as possible Ideally should be directed by senior health worker Needs good team work Needs frequent reassessment of ABCD Priority cases Can receive some treatments while waiting eg pain relief, anti-pyretics

28. Triage - Summary Triage is the sorting of patients into priority groups according to their need All children should undergo triage. The main steps are: Look for Emergency signs (ABCD) Treat any Emergency signs you find Call a senior health worker to see any emergency Look for any Priority signs ( 3TPR MOB) Place Priority patients at the front of the queue Move on to the next patient With practice you will be able to triage in less than 1 minute