i was recently criticized at work for how i triaged a pt. i was wondering how anyone out there may have triaged this pt:
a patient presented to us with a chief complaint of a boil in the left groin region for 3 days. pt stated a hx of these and that they normally drained on their own after 2 days. pt stated this one had not started to drain yet and was becoming painful. pt was requesting to have it lanced. pt VS were stable as listed: HR 86 T99.8 R20 BP 120/80, pain 7/10. pt did not appear to be in distress.
What ESI rating would anyone else have given this pt? any input would be helpful.
That's alright, we have a doctor who starts every story with 'triage gave a patient a cat 4 with an irregular pulse, chest pain, etc.., etc...' then proceeds to tell us how she had to save them.
That's crazy they wanted to send that pt home seeing as that condition has a >75% mortality rate when sepsis is already present. Also interesting is that as of 2007, only 750 cases of Fournier's gangrene has ever been documented.
Don't feel bad. According to the Australasian triage scale I would have given him a 4 as per his initial presentation. I *may* have bumped it to a 3, because his painscore was 7/10. I probably would have though if he's had it for 3 days, he could wait another 60 minutes, but I wasn't there, so it's difficult to judge.
It's why we are constantly reassessing patients as they move and wait through the ED. Things change from the intial presentation.
I always ask people if they have any pmhx. This one particular guy who presented with what looked like an allergy rash & I gave him some phenergan. He denied any history, denied major operations, denied taking meds, denied pain, denied denied denied etc etc. An hour later he dropped his BP in the waiting room, told me he'd had generalised abdo pain for a week. I took him into our monitored area, he still denied a pmhx to all nursing & medical staff. Stripped him off and there was an ileostomy, you name the abdominal surgery and this guy had had it. He'd also had PR bleeding for about 2 weeks. Presented with a rash for which I gave a 4 and was probably going to give a 5 because it really wasn't that bad and he'd had it for a day.
The OP's patient gets a 4 from me as well. We get boils that need to be drained every day and they are a 3 vrs a 4 depending on whether they have signs of systemic infection. No fever...it's a 4
Disclaimer: I completely HATE working in triage...okay, had to get that out LOL...
Based on your description I would say 4, but there are so many variables when triaging a patient such as what they say, how they act, body language, how the site looks, and on and on...
one of the criticisms i received on the triage of this pt was that i did not have him undress to assess the site in triage. our triage has a window in it, so i didn't feel it was appropriate in that setting due to the lack of privacy.
I was just going to say you can't see an abscess in that location at triage so you have to go off what they tell you. I would have never asked them to get undressed at triage! I think you were perfectly right in your triage.
I think my problem lies with the provider that tried to send him home. Obviously you weren't the only one that didn't see the severity of this.
He would have been a 4 and sent to the waiting room at my hospital also. Lately our waits have been up to 8 hours, so upon reassessment, he may have been bumped up. However, if he was stable, he would have waited. You never know what you are going to find when you finally get them in the room. I've had 2's that are 4's and 4's that are 2's. Its a crapshoot.
ESI 3. Febrile, so likely might need IV antibiotics, I&D..... maybe labs so a few resources.
I wrote my response prior to reading what actually was wrong w/ the patient. Holy Crap! That's crazy, that's one of those weird freakish things that make our job interesting. Ignore those that question your triage abilities/assessment/prioritization. Those are the ones that question/complain about EVERYTHING.
dthfytr, ADN, LPN, RN, EMT-B, EMT-I
1,163 Posts
S.O.P. at every hospital I've ever worked at, something goes wrong? Burn a nurse!