Triage blues

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Specializes in ER.

I am in triage for the second time this week and could really use a drink.

Question- 76yo female with cabg in 2002 presents stating she's only used her nitro once since them, but twice has needed it today. Last dose 1 hour ago, then her daughter brought her up. Currently no pain. Triaged with normal vital signs, a little anxious and instructed to return to triage with any hint of pain or change in condition. I triaged her as a 3. What would anyone else triage her as?

I yelled at a visitor today for using triage as a thoroughfare to get in and out of the ER. Yes I am a *****, but also frustrated. Our triage door lock is broken, and we are waiting for parts.

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Specializes in ED, Clinical Documentation.

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

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Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.

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.

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Specializes in Emergency & Trauma/Adult ICU.

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 ...

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Specializes in Trauma/ED.

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...

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Specializes in ER.

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.

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Specializes in ER.

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.

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Specializes in ER, Labor and Delivery, Infection Contro.

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

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