Emergency Department Triage Manual, P

ED Triage Manual, P

Pain-Abdominal
Pain-Chest
Pain-Headache
Pain-Neck
Penile/Scrotal Complaints
Poisoning
Post-Op
Pregnancy
Psychiatric Emergency

Pain-Abdominal

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
	Dark green bilious emesis Firm, distended abdomen Peritoneal irritation Unable to stand erect Increased pain with ambulation Age < 3 yrs with bloody diarrhea and crampy pain Confirmed appendicitis Pain score ≥ 8 < 8 wks post-partum*	Significant abdominal pain Localized abdominal pain	Generalized abdominal pain Constipation	Emesis without signs of dehydration
*< 8 wks post-partum c/o abdominal pain: complete full set of vital signs. If vital signs are stable, consult Attending for transfer to HUP. ESI 1, 2 or 3: Inform child and family of NPO status and place NPO wrist band.

Pain-Chest

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
Absent breath sounds Muffled heart sounds Hemodynamic compromise	Tachypnea Respiratory distress Palpitations Significant tachycardia Hx: cardiac disease Diaphoresis High velocity blunt trauma	Fever Hx: Foreign body Trauma Palpitations	Hyperventilation Rales Non-reproducible chest pain	Cough Malaise Reproducible pain with palpation

Pain-Headache

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
Severe headache with acute mental status changes See Critical Criteria	Severe headache Focal neurologic findings: Slurred speech Nuchal rigidity Atonia/hypotonia Ataxia	Headache not relieved by analgesics		Baseline mental status

Pain-Earache

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
	Redness, swelling and pain over the mastoid area	Swelling, redness of the pinna FB with unsuccessful removal by other provider		Drainage Hearing loss Visible foreign body

Pain-Neck

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
Dystonic reaction with airway compromise	Severe headache Nuchal rigidity Ataxia Hx: trauma with limited ROM neck, cervical tenderness* Dystonic reaction Bulging fontanelle	Fever, hx: fever ≥ 38°C (100.4°F) with torticollis Large cervical adenopathy	Torticollis without fever or trauma Cervical adenopathy	Lateral neck pain
*All patients with hx: trauma, limited ROM to neck, cervical tenderness should be collared and flat on stretcher

Penile/Scrotal Complaints

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
	Acute onset of moderate/severe testicular/scrotal pain or swelling in patients without penile complaints* or Acute onset of moderate testicular/scrotal pain with nausea/vomiting* Priapism	Swelling of foreskin, shaft Gradual onset of non-severe scrotal pain	Dysuria Penile discharge
*Place NPO bracelet on patients meeting high-risk criteria, notify PEM for PE, US order as needed

Poisoning

Consult Poison Control Center (800-222-1222); document information, recommendations; triage accordingly.

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
	Medicinal or chemical exposure within 6 hrs PTA Any symptomatic ingestion/exposure Ingestion/exposure requiring immediate decontamination Any ingestion/exposure associated with suicide attempt	Medicinal or chemical exposure > 6-12 hrs PTA Lead poisoning	Medicinal or chemical exposure > 12 hrs PTA Caretaker requests drug screen	Non-toxic exposure
Note: Exposures include ingestion, inhalation, injection, dermal or conjunctival contact. Decontamination refers to GI decontamination or skin decontamination (showering), or ocular flushing.

Post-Op

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
Profuse bleeding with hemodynamic compromise	Active bleeding Incisional dehiscence Vomiting and/or decreased PO's with: Oliguria Tacky mucous membranes Tachycardia Absent tears Sunken eyes Listlessness	Fever, hx: fever ≥ 38°C (100.4°F) Vomiting Incisional exudate	Incisional erythema Decreased PO's Decreased appetite
Make all children NPO. Do not swab throat for culture.

Pregnancy

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
Vaginal hemorrhage Imminent delivery Acute mental status change	Hypertension
All other complaints: complete full set of vital signs. If vital signs are stable, consult Attending for transfer to HUP.

Psychiatric Emergency

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
	Psychosis Aggressive behavior Uncontrollable behavior Violent behavior Suicidal ideation Hx: Aggressive behavior Uncontrollable behavior Violent behavior	Medical clearance	Hx: acting out
Notify Social Work for Level 2 patients Notify Security of aggressive patients

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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