Emergency Department Triage Manual, C-D

ED Triage Manual, C-D

Cardiac Disease
Choking
Coagulopathies
Constipation
Crying/Colic
Dehydration
Dental Emergencies
Diabetes
Diarrhea

Cardiac Disease

Please page Cardiology upon patient’s arrival for systemic illness complaints with history of pulmonary hypertension, S/P transplant or pre-transplant patients.

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
Pacer malfunction with hemodynamic compromise Acute mental status change Changes in respiratory/circulatory status with hemodynamic compromise See Critical Criteria	Chest pain Fainting/syncope Systemic illness (i.e., fever, URI, dehydration, V, D) with history of: Pulmonary hypertension Heart and/or lung transplant Awaiting heart and/or lung transplant Loss of access for Remodulin infusion without other symptoms Cardiac surgery within preceding month	Cough Poor feeding Decreased urine output Fever, hx: fever Incisional drainage

Choking

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
Marked stridor or Inability to speak with respiratory compromise Acute mental status change See Critical Criteria	Dysphagia Drooling Tachypnea Wheezing Unequal breath sounds Decreased breath sounds	Hx: significant choking episode with reported cyanosis or known foreign body	Hx: significant choking episode with symptoms now at baseline	Hx: choking episode, no suspicion of foreign body

Coagulopathies

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
Significant active bleeding Closed head injury with: Acute MS change Seizure	Closed head injury without mental status change New onset, worsening petechial/purpuric rash Tachycardia Pallor Laceration with active bleeding Epistaxis Impaired distal neurovascular status Blunt torso injury Gross hematuria Muscle or joint bleed Pt referred to ED for correction	Resolved epistaxis Laceration without active bleeding History of minor extremity trauma with superficial exam findings only (i.e., abrasion)

Constipation

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
	Severe abdominal pain	Abdominal distension Rectum prolapsed	Intermittent abdominal pain with hard stool	Hard or infrequent stools without associated symptoms

Crying/Colic

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
Weak/moaning cry	Irritability with: Nuchal rigidity Bulging fontanelle Inconsolability Petechial rash Bloody diarrhea Hair tourniquet Active crampy abdominal pain			Crying, consolable Teething Recent immunization Pulling ears Hx: Eye tearing in infant > 2 mos

Dehydration

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
Pre-existing metabolic condition with signs of hypoperfusion or acute mental status change	Tachycardia Focal or severe abdominal pain Sunken fontanelle Sunken eyes Prolonged capillary refill > 2 secs Pre-existing metabolic disease Diabetes	Listless Oliguria	Tacky mm Decreased tears Mild tachycardia	Vomiting Diarrhea Decreased intake

Dental Emergencies

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
Copious intraoral bleeding	Permanent tooth: Avulsion* – tooth provided for reimplantation Extrusion Suspected alveolar ridge fracture Severe intraoral swelling Significant localized swelling	Permanent tooth: Avulsion – tooth unable to be found Bleeding/pain Tooth fracture: No pulp exposed	Primary tooth injury: Bleeding/pain Localized swelling Tooth fracture: No pulp exposed	Primary tooth avulsion without: Bleeding/pain Toothache
*Triage RN should immediately place tooth in Save-A-Tooth solution and alert MD for rapid reimplantation. If known or suspected facial trauma, refer to Trauma Face for additional triage considerations

1 Critical

2 Acute

3 Urgent

4 Urgent

5 Non-Urgent

Copious intraoral bleeding

Permanent tooth:
- Avulsion* – tooth provided for reimplantation
- Extrusion
Suspected alveolar ridge fracture
Severe intraoral swelling
Significant localized swelling

Permanent tooth:
- Avulsion – tooth unable to be found
- Bleeding/pain
Tooth fracture:
- No pulp exposed

Primary tooth injury:
- Bleeding/pain
Localized swelling

Tooth fracture:
- No pulp exposed

Primary tooth avulsion without:
- Bleeding/pain
Toothache

*Triage RN should immediately place tooth in Save-A-Tooth solution and alert MD for rapid reimplantation.
If known or suspected facial trauma, refer to Trauma Face for additional triage considerations

Diabetes

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
Severe acute alteration in mental status Cardiorespiratory compromise	Change in mental status with 2 or more: Polyuria Polyphagia Polydipsia Weight loss Kussmaul respirations Vomiting	Normal PE with reported high blood sugar +/- ketones in urine 2 or more: Polyuria Polyphagia Polydipsia Weight loss	No medications at home

Diarrhea

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
Metabolic disease with respiratory/circulatory compromise	IBD with bloody diarrhea, crampy abdominal pain Bloody diarrhea < 3 mos of age Pallor Active bleeding Metabolic disease	Bloody with: Crampy abdominal pain	Well-appearing with or without fever Streaks of blood in stool	Adequate hydration

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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