Triage Emergency Care Quiz

Test your knowledge of triage emergency care in remote Australia with this quiz adapted from CRANAplus’ pre-course online learning. Correct answers are shown at the bottom of the article.

Read the following scenarios and assign a triage category for each presentation. Helpful hint – utilise the new ETEK Version 2 as a reference guide.

1. A 24-year-old woman presents to ED with onset this afternoon of bright red PV loss with associated left lower abdominal pain described as cramping in sensation. She has soaked through two pads in the last hour. Pain is 8/10 and she feels nauseated. On further questioning, she is late for her menstrual period and has been actively trying with her partner for a baby. She is also complaining of shoulder tip pain. Observations are: HR 102, BP 100/70, Spo2 99% on RA, RR 24, Afebrile 36.8.
2. A three-year-old child presents to your clinic – he was playing in the garden this afternoon and had a fall. He has a penetrating eye injury with a 2cm stick lodged in the inner corner of the cornea and through the upper eyelid. He is crying and extremely distressed at triage. You are unable to complete a full set of observations due to distress but note that he is warm, well perfused and while crying his respiratory rate is 36.
3. A 37-year-old man presents with right upper quadrant pain, onset yesterday evening post eating a home-cooked meal of rice and fish. He is nauseated and has vomited twice in the waiting room. He states his pain is 6/10 after having some paracetamol two hours ago. He tells you this feels like his last “gallstone attack”. His observations are: HR 89 regular, BP 143/70, Spo2 99% on RA, RR 20, Temp 37.3.
4. A 32-year-old woman presents to your clinic with a close friend with a two-week history of increasingly bizarre behaviours at home – the friend states that the patient is responding to hallucinations and has mentioned hearing voices that are loud and angry. The patient denies any thoughts of self-harm or harm to others. The patient is mildly agitated but calms down when engaging with you. Her mood is slightly elevated but she states she wants help and wants to get back on her regular medications. On questioning, she has previously been on a psychiatric depot medication.
5. You are working at the clinic when a ute pulls up and a distressed family member urgently asks you for help outside. On arrival outside after checking for danger, you see an unconscious female in the back of the ute tray. The family member states that the patient was riding a horse this afternoon and was bucked off, landing on the ground. Initially, she was responsive and complaining of head and neck pain with an obvious fracture and deformity of her R) arm. On the ride into town the patient became more and more drowsy and is now unresponsive. During your primary survey of this patient you note – Airway: gurgling sounds (you consider cspine immobilisation to follow given the mechanism), Breathing – RR 8 shallow, Circulation – rapid, thready pulse, Disability – Unresponsive on the AVPU scale. You call for help to move her into the clinic.
   

Correct answers

1. Cat 2 – shoulder tip pain is suggestive of intraabdominal free fluid with a query ectopic pregnancy. Confirm urine Beta HCG as soon as possible. Severe Pain score of 8 warrants timely management.
2. Cat 2 – penetrating eye injuries are treated as per the ETEK as a Cat 2. The child is also distressed with pain and this warrants timely management.
3. Cat 3 – moderate pain with a history of gallstones requires review within 30 mins. Consider analgesia and an antiemetic while in the WR if possible.
4. Cat 3 – as per the ETEK guidelines this patient fits the descriptors for a category 3 Mental Health Triage – this includes: the presence of hallucinations/delusions, mild agitation, and mildly elevated mood. Think carefully about where in your clinic is safest for this patient to wait and have a low threshold for up-triaging this patient to a more urgent triage category if her behaviour becomes more elevated or there is a risk of harm to herself or others.
5. Cat 1 – the patient has an altered level of consciousness with an inability to protect their own airway, and respiratory effort is altered with a low resp rate. You are concerned for head injury, and potential cervical spine injury and need to complete a more detailed secondary survey to assess for any further serious injury.