Triage blues

with her age and history i would have made her a 2. how did things turn out?

Yes, I agre w/GleeGum: make her a higher level.

1) Any female over 40-45ish with pain above umbilicus, think cardiac first; they tend to present atypically versus males.

2) A degree of atherosclerosis is expected with aging, thus the SBP may elevate "normally"....so this pt's "normal" VS may actually be "low" for her

3) If she has a "normal" HR, this may actually be under the influence of a Beta-blocker as she has had cardiac disease. So you may not see an altered sympathetic response of the HR with a beta blocker.

But then again, I'm just assuming about the Beta Blocker.

The "clincher" for me would probably have been whether or not her CP was improved by the NTG. If so, I would probably have bumped her up to a 2.

I hear ya ... I gots the triage blues too ...

If we were full I would definitely get an EKG in triage, find out more about the pain she had that caused her to use Nitro and I agree age and hx should make this patient higher priority than other 3's (like your abd pains), but I would not place her in front of someone who was having active CP (not the 19yr anxiety though)...this kind of case is when communication with the charge nurse is key...

We were full, and the NTG did help each time she took it. I totally see the logic now of making her a 2. At the time I was thinking that as long as she stays pain free she can hold off a bit. EKG showed no changes from norm for her, but I missed the final disposition as I was swamped also. I guess stress makes you stupid sometimes. Her daughter came back and questioned me about it, so I went in and got some second opinions from coworkers, and ended up sending her right back.

I am going to be breaking records in triage this week with a final total of 32 hours.

I wopuld have made her a 2 due to her age and past medical hx. Being elder and female she may not feel pain like a younger premenoupaussal female.

Hey canoehead,

First-I just want to let you know I always value your experiences and thoughts on this board.

My other thought was does your ER have a guidelines for triage book (one specific for your facility, not just generic) for you to refer too? I know you have been doing this for a while, but i was just wondering what your reference book would suggest .

Sometimes it's in hindsight....sigh

Don't let it get you down-learn/remember go-don't forget to look at all the good/right/positive you do throughout your day!

alwayslearnin