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PRINCIPLES OF EMERGENCY CARE By definition, emergency care is care that must be rendered without delay.

In a hospital ED, several patients with diverse health problemssome life-threatening, some notmay present to the ED simultaneously. One of the first principles of emergency care is triage. TRIAGE The word triage comes from the French word trier, meaning to sort. In the daily routine of the ED, triage is used to sort patients into groups based on the severity of their health problems and the immediacy with which these problems must be treated. Hospital EDs use various triage systems. A basic and widely used system uses five levels of acuity with 4 categories: resuscitation, emergent, urgent, and non-urgent Emergent patients have the highest prioritytheir conditions are life threatening, and they must be seen immediately. Urgent patients have serious health problems, but not immediately life threatening ones; they must be seen within 1 hour. Non-urgent patients have episodic illnesses that can be addressed within 24 hours without increased morbidity (Berner, 2001). A fourth, increasingly used class is fast-track. These patients require simple first aid or basic primary care.

Triage Level I - Resuscitation


Conditions requiring immediate nursing and physician assessment. Any delay in treatment is potentially life- or limb-threatening. Includes conditions such as: o Airway compromise. o Cardiac arrest. o Severe shock. o Cervical spine injury. o Multisystem trauma. o Altered level of consciousness (LOC) (unconsciousness). o Eclampsia.

Triage Level II - Emergent


Conditions requiring nursing assessment and physician assessment within 15 minutes of arrival. Conditions include: o Head injuries. o Severe trauma. o Lethargy or agitation. o Conscious overdose.

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Severe allergic reaction. Chemical exposure to the eyes. Chest pain. Back pain. GI bleed with unstable vital signs. Stroke with deficit. Severe asthma. Abdominal pain in patients older than age 50. Vomiting and diarrhea with dehydration. Fever in infants younger than 3 months. Acute psychotic episode Severe headache. Any pain greater than 7 on a scale of 10. Any sexual assault. Any neonate age 7 days or younger.

For the patient with an emergent or urgent health problem, stabilization, provision of critical treatments, and prompt transfer to the appropriate setting (intensive care unit, operating room,general care unit) are the priorities of emergency care.

Triage Level III - Urgent


Conditions requiring nursing and physician assessment within 30 minutes of arrival. Conditions include: o Alert head injury with vomiting. o Mild to moderate asthma. o Moderate trauma. o Abuse or neglect. o GI bleed with stable vital signs. o History of seizure, alert on arrival. Less Urgent

Conditions requiring nursing and physician assessment within one hour. Conditions include: o Alert head injury without vomiting. o Minor trauma. o Vomiting and diarrhea in patient older than age 2 without evidence of dehydration. o Earache. o Minor allergic reaction. o Corneal foreign body. o Chronic back pain.

Triage Level IV - Nonurgent


Conditions requiring nursing and physician assessment within two hours. Conditions include: o Minor trauma, not acute. o Sore throat. o Minor symptoms. o Chronic abdominal pain