Triage (Chapter 1)

Learning objectives

After completion of this session the participant should be able to:

Define triage
Describe how to triage
Understand ABCCCD and priority concept
Demonstrate triage skills

‘Triage’ means ‘sorting’

Triage is the process of rapidly assessing all sick children when they first arrive in hospital and sorting them according to their need.
Triage assessment can be done anywhere such as in outpatients, or the ward.
Triage should be carried out, on arrival, to all new patients to the hospital.
Triage can be done by any trained person – e.g. a health worker, a receptionist, a guard.

Those with life threatening illness must be seen immediately as EMERGENCIES.
Those who are less sick must be seen next and are PRIORITIES.
Those who are NON-URGENT cases can wait their turn in the QUEUE.

EMERGENCY [E] patient must be seen at once
may need life-safing treatment

PRIORITY [P] patient needs rapid assessment
needs to be seen soon

NON-URGENT* [Q] patient can safely wait to be seen
* NYI are never in this category

EMERGENCIES

Emergencies are sent straight to the best place for resuscitation.

The ABCCCD concept is used to identify emergencies. This is a logical and quick way of identifying how sick a child is; it does not take the place of a thorough examination to make a diagnosis but is a screening tool to identify problems that require immediate attention.

For triage, we need to know:

	Emergency Signs	Emergency Treatment
Airway and Breathing	Not breathing Centrally cyanosed Noisy breathing Severe respiratory distress	Manage the airway Give oxygen If present, remove foreign body, BMV
Circulation	Cold hands Capillary refill of > 3secs Weak and fast pulse	Manage the airway Give oxygen Start fluids 10ml/Kg IV
Coma/ Convulsions	Unconscious Convulsing Low blood sugar	Manage the airway Give oxygen Give 10% Dextrose IV Position the baby
Dehydration	Lethargy Sunken eyes Prolonged skin pinch >2secs	No Malnutrition Give IV fluids +NGT Severe Malnutrition Give NGT, try to avoid IV

Also see

PRIORITIES

Priorities are sent to the front of the queue to be seen quickly.

When emergencies have been excluded, signs and symptoms for priority are looked for. Priority signs can be remembered with the letters 3TPR, MOB. Remember that all infants less than 2 months of age are priorities. This is because infants can deteriorate rapidly; they are difficult to assess without a thorough examination; and to prevent them remaining in a queue exposed to infections from other children.

Priority signs are:

3Ts	Tiny (less than 2 month of age) Temperature (high temperature as judged by your hand) Trauma
3Ps	Pain Pallor Poisoning
3Rs	Respiratory distress (not life threatening) Referral (urgent) Restless
MOB	Malnutrition Oedema Burns

EMERGENCY [E]	patient must be seen at once may need life-safing treatment
PRIORITY [P]	patient needs rapid assessment needs to be seen soon
*NON-URGENT [Q]**	patient can safely wait to be seen * NYI are never in this category