Triage question

needsmore$ · Jan 10, 2005

We use a 5 tier system- level1 to 5 (minor to emergeny). Similiar based system to the Canadian triage systemEye injuries were always taught to me as 'urgent at least' and then depending on whether the globe has been penetrated or not-emergent. (talking about injury not medical ,like glaucoma issues) We do have protocols in place for administration of tetracaine (if meets the criteria) for pain control. Here is the Canadian triage link-endorsed by ENA (canada), etc. I couldn't find a link on the ENA web site but you could check there as well-they have position statements on a range of topics

www.ena.org

http://www.caep.ca/002.policies/002-docs/ctased16.pdf

Good luck

Anne

Trauma Columnist · Jan 10, 2005

We use the ENA criteria also and would provide tetracaine as needed until seen by MD. We might also loosely patch the eye for comfort.

veetach · Jan 11, 2005

I was just about to mention the ENA 5 level triage system. No matter what triage system you use, though, a fb in the eye is an urgent situation. He should have been triaged above non urgents.

Now, as a bit of a disclaimer, I have seen ER's where the urgent patients have to wait 3 hours because there are so many emergent patients that they bump the urgents back.

maturner · Jan 11, 2005

Provided a good hx and assessment of the injury was performed by the triage nurse and pt has good pain control why can't a corneal FB wait? Unless there is a mechanism, visual disturbances, or severe pain issues indicating a greater potential for injury and thus requiring a higher acuity level there should be no reason why a FB can't wait in the cue as semi urgent. Three hours is a long wait and some tetracaine would have probably been a Godsend but really unless the patient had any of the aformentioned problems they were probably triaged accurately.

needsmore$ · Jan 11, 2005

I guess that FB of the eye has the potential to be something worse--hence the URGENT designation. May be hard to assess at triage to make sure that the FB didn't penetrate the globe without a full exam. I know that although designated as urgent- depending on history of problem (mechanism) and length of time elapsed since onset- I have triaged many eye problems that seemed to be nonurgent- I had pain control in place- VA within norms and a department full of higher acuity medical complaints. THis is where experience comes in as well--

Anne

Lawdo2 · Jan 14, 2005

Is there a standard protocol for traiging pts who come into the ER? The reason I am asking is because my DH went to the ER for a foreing body (piece of metal) in his cornea. He was traiaged as green and we waited in a room for greater than 3 hours without seeing anyone after the nurse initially left the room. I wen to the nurses station 2 times and still no one came in to check on him.
The hospital I work at automatically puts all foreign body in cornea as a yellow, secondary to potential loss of vision. I am looking for a published protocol that I can access so I can take it with me to a patient advocate. I want to get the bill decreased from almost $4000. I have already paid the Dr his part, but refuse to pay the hospital for us sitting in a room without pain medicaion and NO nursing care.

Emergerncy nurses Association had put out a manual on triage. THERE IS A STANDARD OF CARE.

mommatrauma, RN · Mar 6, 2005

We use a 5 tier triage system...without obvious globe injury and visual disturbance...in my experience...i would have made it green and you would have been seen in fast track...is their potential for further injury? sure...walking can be dangerous...there is potential for head injury but does everyone walk around with a helmet "just in case," of course not...but hopefully you get my point...I always make it a point when I triage to tell my patients that if their symptoms get worse or change to let me know so I can reassess and re-level should the need arise...Otherwise, thank you, have a seat and they will call you when they are ready for you...Of course, there are guidelines set up with the tier system that if a pt can't be seen within a certain amount of time designated for their "level," they must be reassessed in triage...We are the first line...we need to educate as well as treat...