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Does anyone out there know of any good books about triage? I want as much information possible when I'm out there deciding who's sick enough to go back, and who's OK to wait!

It can get pretty gray when we're busy, and that scares me! Any pearls of wisdom would also be appreciated! :)

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Specializes in ER, PACU, OR.

tricia, well 1st thing to remember.........is no matter how good a book is, it's not the same as the real thing. look at the patient, talk to the patient, find out what's wrong with the patient. nobody ever died from a cholecystitits attack in the wr. on the other hand........somebody with chest pain, or loss of neuro status could.........just use your head! :)

me!!!!

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best advice:

trade spots with a a coworker so you dont have to be in triage. - thats only because i loathe triage..

only practice can make a better triage nurse. did your dept orient you well to the position?

if you are worried about a patient, consult with the charge nurse.

One day i had a post fall person with ataxia and an elderly pt with belly pain wait almost 30 minutes to get back to a bed. no place to go - beds were full.

the ataxia was a bad bleed that went to surgery, as was the belly pain which was an abdominal aneursym.

so ya never know....

i like to get pulse oxs on elderly pts with complaints of confusion or weakness. i have had plenty that were hypoxic - so at least i could hook them up with an o2 tank while they are waiting (30 min- 2 hours at our ed) for a bed.

good luck.

and be careful with ambulances, here is what happened to me one day in triage !!!!!!!!!!!!

http://www.ohio.com/bj/local/docs/027258.htm

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here is the text of the expired link..

Akron Beacon Journal

BY CHERYL POWELL

The Akron City Hospital ER got hit with an emergency of its own yesterday. But

this trauma called for a door repairman, not a doctor.

A woman crashed a stolen Akron Fire Department ambulance into the hospital's

emergency room entrance shortly after 3 p.m.

No one was injured, police said, but the seemingly made-for-TV drama did cause quite a commotion in the busy department, where about 30 patients were

waiting to be seen.

``I just heard the siren and all of the sudden, I looked up and there was an

ambulance coming closer -- and then it came a little too close,'' said Dan Lane,

a registered nurse in the emergency room who was about 30 feet away from thedoorway.

``There was actually no one in the doorway when it happened,'' he said. ``But there were some people who needed to be calmed down.''

Richelle Woodall, 22, of Akron was charged with auto theft, willful fleeing and misconduct in an emergency in connection with the incident. The ordeal started when two Akron paramedics and a police officer went to help

a pregnant woman who was punched in her stomach outside the AkronSummit County Public Library on South Main Street.

The ambulance was parked behind Sgt. Augie Macozzi's cruiser with its lights still flashing.

Suddenly, Macozzi said, people on the street were yelling and pointing as the ambulance clipped his cruiser, took off down Main Street and then traveled east on Market Street.

`I got into the cruiser and took off after the med unit,'' Macozzi said. ``It was relatively slow -- about 30 miles per hour. Nothing erratic, nothing reckless.''

The ambulance turned into City Hospital's ER driveway, ``slowed down, and then hit the doors,'' Macozzi said.

Several police officers quickly surrounded Woodall, who was crying and didn't put up a fight, Macozzi said. She didn't say why she had taken the ambulance and driven it into the hospital.

Police and Fire Department officials said they weren't sure whether the paramedics left the keys in the ignition.

Macozzi said there was no evidence the vehicle was hot-wired. Fire Department policy calls for paramedics to take the keys with them when they leave the ambulance, Lt. Al Bragg said.

`We're investigating that right now to find out exactly what happened,'' said Bragg, who declined to name the paramedics.

The paramedics stayed with the pregnant woman outside the library until a private ambulance company arrived to transport her to a local hospital, Bragg said.

The Fire Department also sent another ambulance to take Woodall to St.Thomas Hospital, where she said her psychiatrist is located, Akron Police Sgt.

Bruce Graham said.

This time, however, she rode in the back.

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Specializes in NICU.

Isn't this scary...

When I was in nursing school I did a summer elective in the ER with a preceptor. We did evening shifts and one night the ER was really busy. My preceptor was asked to start covering triage and since I was his preceptee, I was to follow.

He triaged a few pts to show me what to ask and what to fill in on the triage sheet. I got a crash course on how to assess TB risk and DV.

Now the scary part... Since it was busy, he had ME--a 2nd year nursing student--triaging pts at one desk while he was triaging at the other! As if you can learn how to triage in 5 minutes! I was to decide whether to send the pt directly back to our ER, or back to the waiting room. I pretty much just sent everyone back the waiting room, to be seen when beds were available. No one SEEMED emergent, BUT that also assumes I properly asked the right questions and did the right assessments. Triage is obviously more than VS and asking when your last menstrual period was.

Scary, huh? I still shudder when I think about that. I guess he was halfway watching what I was doing, but HE never looked at the pts since he was triaging his own. I don't think should have really trusted me to decide those things!

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I guess triage just scares me a little right now...some hospitals around here have policies that say you have to be an RN in the ER for 6 months before you're allowed to start doing triage, but mine does not. The director and manager told me it would be OK if I waited 6 months, but I can tell people are already starting to push me into doing it now...I know I can refuse, but I don't want to seem like I think I'm "special." There's another new grad in the ER, and she seems to be fine with everything and not scared of anything (which isn't necessarily always good either, I know.)

I know the bottom line is good pt care, and my comfort level though...luckily, one of the charge nurses who was one of my preceptors is supportive of my opinion, and agrees that waiting for 6 months is very reasonable.

I hear some of the triage stories...one of the educators was talking about a time he was in triage and a diabetic woman came in with abdominal pain. He took into account her risk factor for MI, being diabetic, and the fact that women often have atypical s/s with MI's and took her back to do an EKG...and she was having a huge anterior MI. Something like that, I'm afraid I wouldn't catch.

I'll be glad when I'm not a rookie anymore!

Thanks for the input everybody! :)

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As a new ED nurse you should fear triage. I have been a ED nurse for 15 yrs and triage is still a little scarey for me. Books are nice to read however it is you gut feeling that will save you most of the time.. Be careful with the patient that doesn't want to "bother the Nurse" or the elderly man who will let a screaming kid go before him. They are the type of patients that will come back haunt you.Good luck....:rolleyes:

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