The young man Xiao Zheng came to the emergency department due to an attack of chest pain, Lu Chenxi diagnosis of tension pneumothorax, the need for emergency closed drainage of the chest.
Then, the emergency nurse is based on what, the young man sent to the rescue room, and timely call Lu Chenxi, timely and accurately for the young man to implement an effective treatment?
The basis is the emergency pre-screening triage.
The emergency pre-screening triage is based on the severity of the disease, the principle of treatment priority and rational use of emergency resources to continue the rapid classification of emergency patients to determine the priority of treatment or further processing works.
The triage of chest pain, how to do as far as possible not to miss the diagnosis, timely and effective patient rescue?
I am looking at the relevant literature, the ABCDE process of standardized triage standardized triage organized this article for colleagues interested in emergency triage to share and learn.
Emergency triage addresses three issues.
1. Triage at what level?
The lad's triage level is level 2, to the resuscitation room.
Triage standards in accordance with the Ministry of Health "emergency patient condition grading guidelines", that is, the establishment of red, yellow and green four zones, triage of patients from the first to the fourth level.
The first level of endangered patients to deal with immediately: the condition of the patient's life may be endangered at any time, such as endotracheal intubation patients, no respiratory / pulseless patients, patients with acute impaired consciousness, unresponsive patients, need to be taken immediately to save the life of the intervention measures.
Level II critical patient management: the condition is likely to progress to level I in a short period of time, or may lead to severe disability, such as acute confusion/disorientation, compound injuries, angina, and so on. Severe pain (pain score ≥ 7 / points) should be arranged as soon as possible to receive, and give the patient the appropriate disposal and treatment.
Level III Emergency Patient Handling: patients with acute symptoms and emergency problems, but currently clearly no life-threatening or disabling risks, should be scheduled to see the patient within a certain period of time.
Level IV non-emergency patient management: mildly ill patients or non-emergency patients, patients currently have no acute morbidity, no or few complaints of discomfort.
Red zone: critical rescue area (applicable to the first and second level of patient care)
Yellow zone: close observation of the treatment area (applicable to the third level of patients, in principle, in accordance with the chronological order of the disposal of the patient, when there is a change in the condition of the patient can be consulted in advance, the condition of the change in the severity of the red zone immediately)
Green zone: Emergency general diagnosis and treatment area (for the disposal of the fourth level of patient care)
p> 2. Why?
Standardized triage according to the ABCDE triage process.
Initial assessment:
A: Airway, cervical spine.
Airway free of foreign bodies and cervical spine free of injury.
B: Respiration
The patient is seated in the upright position with a respirometry value of 36 breaths/minute and a blood pressure saturation of 90%.
C: Circulation
Heart rate is 90 beats/min, blood pressure is 110/70 mmHg in the left upper extremity and 100/60 mmHg in the right upper extremity.
D: Neurologic
Consciousness is clear.
E: Environmental
Body temperature 36.5, no skin breakdown, pain >5. Pain initiation mode and progression, site right chest, pain is getting worse, beginning to sweat profusely.
Information that must be taken:
Negative symptoms that must be screened for
Examine the electrocardiogram for any abnormalities, and whether the blood pressure in both upper extremities is more than 20 mmHg.
Diseases that must be taken into consideration
Tension pneumothorax, acute pulmonary embolism, acute pneumonia, intercostal pain, hyperventilation syndrome.
3- What disposition to take.
Transport to the resuscitation room.
A The airway needs to be unblocked immediately after a problem arises, and tracheal intubation is required in an emergency.
B Give high-flow oxygen by mask, 3L/min, in the sitting position.
C Open venous access, collect blood gases, and retest blood pressure in both upper extremities.
DGCS score <8 requires urgent intubation.
E bedside electrocardiogram, chest X-ray, physical examination, a history of trauma emergency CT.
According to the ABCDE changes at any time subdiagnosis, when the patient appeared to be dying, respiration & gt;35 or & gt;9 times / minute, pain & gt;8 points, blood pressure & gt;90/60mmHg, head CT shows abnormalities and other signs of any of these items need to be upgraded to subdiagnosis diagnosis for The first level, if necessary, the relevant specialists to consult the doctor.
In general, for patients complaining of chest pain:
Grade 1 includes shock, cardiac and respiratory arrest, and convulsions;
Grade 2 includes systolic blood pressure <90mm㎎, asymmetric blood pressure, pain score >7, crushing pain, and history of cardiovascular disease;
Grade 3: pain assessment >5, trauma;
Grade 4: pressure pain, intercostal pain.
The use of ABCDE standardized triage system can ensure the quality of emergency triage with its convenient and efficient process, which is of vital significance for the identification of chest pain, which can effectively identify patients with high-risk chest pain, determine the emergency treatment, and improve the success rate of resuscitation.
Regarding emergency pre-screening triage, what other triage systems are available in China, and what is the actual operation? Welcome teachers to share their comments at the end of the article.
References
1. Zhao Heihe. Zhu Xiaoping et al. Emergency triage guide [M]. Wuhan: Wuhan University Press, 2013.5.
2. Health Planning Commission. Pilot guiding principles of emergency patient condition grading (draft for comments).2011.8.