Ch 80

​

​

​

​

​immediate urgent minor extensive

immediate care

​

rapid attention

​

can wait in the queue

​

Emergency

​

Priority

​

Non-urgent​

Levels of triage

Who should triage?

All clinical staff involved in caring for the acutely ill child should be prepared to carry out rapid assessment.

Where to triage?

​Airway

Breathing

Consciousness/Coma/Convulsion

Dehydration​

WHO 2008. Manual for the Health Care of Children in Humanitarian Emergencies. Geneva.

​As soon as the child arrives, before any administrative procedure, clinical staff should follow the ABCD steps:

​Reassess -

If a child with emergency signs is identified in the queue, care should be provided immediately.

Some text here about the topic of discussion

Multiple Choice

A 6-year-old female presents to the ER in respiratory distress.

Vital signs: BP 85/55 mmHg, HR 130/min, RR 35/min, T 37^oC, O2 sat 92%

• Stable

• Unstable

• Not enough information

Multiple Choice

HPI: She is a known case of bronchial asthma, well-controlled until few minutes prior to consult, when she experienced sudden onset of respiratory distress.

Hence brought to ER.

• Stable

• Unstable

• Not enough information

Multiple Choice

PE:

(+) alar flaring

symmetrical chest expansion,

(+) suprasternal retractions, (+) subcostal retractions, (+) intercostal retractions, hyperresonant to percussion over both lung fields,

(+) wheezes all over, with poor air entry

• Stable

• Unstable

• Not enough information

Poll

Next step?

• oxygen

• inform seniors:

  PGI and PROD

• salbutamol

  1 nebule stat

• get ABG

  (arterial blood gas)

Multiple Choice

A 4-year-old female presents to the ER with fever.

• Stable

• Unstable

• Not enough information

Multiple Choice

Vital signs: BP 120/80 mmHg, HR 130/min, RR 26/min, T 39^oC, O2 sat 99%

• Stable

• Unstable

• Not enough information

Open Ended

Give 1 differential diagnosis.

HPI: 5 days prior to consult, remittent fever 39^oC to 39.5^oC no other associated symptoms. 3 days prior to consult, maculopapular rash, still with remittent fever.

Today is the 6th day of fever, not relieved by paracetamol at the correct dose, hence consult.

Multiple Choice

PE:

Irritable, (+) conjunctivitis with peri-limbal sparing,

(+) strawberry tongue, (+) diffuse polymorphic rash,

(+) palpable 1.8x1.8cm cervical lymph node on the right,

swelling of both hands

What is the working impression?

• measles

• TB lymphadenitis

• Kawasaki Disease

• roseola

• scarlet fever

Harriet-Lane Handbook

Multiple Choice

A 5 days old newborn female presents to the clinic with a chief complaint of fever.

Vital signs: BP 90 mmHg systolic, HR 140/min, RR 50/min, T 37.8^oC, O2 sat 97%

• Stable

• Unstable

• Not enough information

Open Ended

HPI: Last night, mother noticed poor suck on direct latch breastfeeding, fewer wet diapers overnight until this morning, and then fever started this morning,

hence consult at the clinic. 

Type 1 question that you will ask in the History-taking.

Shock

CCTV-R of Severe Dengue

Color

Capillary refill

Temperature

Volume of the pulse

Rate of the pulse​

Dr Lucy Lum

Poll

PE of the 5 days old newborn is essentially normal, except for abdomen:

globular, intact umbilical stump, hypoactive bowel sounds, soft, no organomegaly

Next step?

• oxygen

• inform seniors (PGI and PROD)

• CBC with platelet count,

  blood culture

• insert IV for antibiotics

Multiple Choice

A 10-year-old male presents to the clinic with a chief complaint of watery eyes.

• Stable

• Unstable

• Not enough information

Open Ended

Give 1 differential diagnosis.

Multiple Choice

Vital signs: BP 130/100 mmHg, HR 130/min, RR 20/min, T 41^oC, O2 sat 97%

• Stable

• Unstable

• Not enough information

Open Ended

Give 1 differential diagnosis.

Multiple Choice

HPI:

2 days prior to consult, machinery digging started on the asphalt road at home.

He experienced watery nasal discharge, his nose felt blocked all day.

He took Loratadine 10mg/chewtab as needed.

Few minutes prior to consult, his tears were flowing constantly, hence consult.

What is the most likely pathophysiology?

• anaphylaxis

• allergic rhinitis

• loratadine

• construction dust

Poll

In a pedestrian to motor vehicle accident, you are the third responder.

Colleagues are attending to the adult pedestrian and the motorcycle driver.

The other injured patient is about 10-12 years old, male.

Patient is in the street, prone, unconscious, no active bleeding externally, but appears to have a closed fracture over the forearm.

Next step?

• turn the patient supine

• get the pulse and respiratory rate

• inform seniors (PGI and PROD)

• splint the fracture

Poll

A 6-year-old male presents to the OPD clinic with a chief complaint of fever.

He is a known case of Duchenne Muscular Dystrophy.

HPI: 3rd day of cough, 1st day of fever.

Vital signs: BP 85/55 mmHg, HR 130/min, RR 35/min, T 37^oC, O2 sat 92%

• Triage to ER

• Manage at OPD

• Not enough information

Poll

A 4 year old female presents to the ER with a chief complaint of fever.

Vital signs: BP 100/70 mmHg, HR 100/min, RR 24/min, T 38^oC, O2 sat 99%

HPI: It is her 3^rd day of intermittent fever, Tmax 38^oC

with temporarily relief after intake of Ibuprofen 3 mkdose q6 prn.

• Manage at ER

• Triage to OPD

• Not enough information

Poll

A 12-year-old female presents to the clinic with a chief complaint of diarrhea.

Vital signs: BP 110/70 mmHg, HR 130/min, RR 20/min, T37.5^oC, O2 sat 100%

• Triage to ER

• Manage at OPD

• Not enough information

The triage process

​It should not take much time. (20 sec)

The clinician can assess several signs at the same time.​

Look for priority signs. (central cyanosis, retractions, malnutrition)

Listen for abnormal sounds. (stridor)​