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1Eureka Presentation
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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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
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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
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SEMI-URGENT
CAN WAIT EXTENDED PERIOD OF TIME
1 RESOURCE ANTICIPATED
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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
