Being A Triage Nurse

Triage

- Classifying victims according to the severity of the injury, urgency of treatment and place of treatment

- In an ER: classifying clients according to their need for care and establishing priorities of care, kind of illness, severity of illness and resources available

- Commonly used system: Three-Tier System

Triaging is done if there are more victims than health responders.

Reverse Triaging is done during Search and Rescue stage where the priority is to get as much people out of danger with the least effort.

 Triage Rating Systems

Five-Tier (Military Triage)

Victim is dead or will die

Emergent: life-threatening injuries but readily correctable

Urgent: victim must be treated within 1-2 hours

Non-urgent: Delayed; non-critical or ambulatory; victim has no injury and no treatment is necessary

No Injury

Four-Tier System

Immediate – Emergent; victim is seriously injured but has a reasonable chance of survival

Delayed – Non-Urgent; victim can wait for care after simple first aid

Expectant – victim is extremely critical and dying

Minimal – no impairment of function and can treat self or be treated by a non-professional

Three-Tier System – HEALTH CARE

Life-Threatening – Emergent – victim has life-threatening injuries but they are readily correctable

Urgent – victim must be treated within 1 – 2 hours

Non-Urgent – Delayed; victim has no injury, is non-critical or is ambulatory

Two-Tier System

Immediate:

victims who have life-threatening injuries that are readily correctable on the scene (emergent) and victims who must

be treated within 1-2 hours (urgent)

Delayed:

basically non-urgent; no injuries, non-critical injuries, are ambulatory are dying or are dead

Emergency Department Triage

Emergent (Red): Priority 1 *Highest Priority

life-threatening injuries; needs immediate attention, continuous evaluation; still possess a high probability for

survival once stabilized

Urgent (Yellow); Priority 2

Injuries have complications that require treatment but are not life-threatening; can be treated within 1-2 hours;

require continuous evaluation every 30-60 minutes

Non-Urgent (Green): Priority 3

classification given to clients with local injuries who do not have immediate complications and who can wait several

hours for medical treatment; requires evaluation every 1-2 hours

Emergent (Red)

trauma, chest pain, severe respiratory distress or cardiac arrest, limb amputation, acute neurological deficits, chemical splashes to the eyes

Urgent (Yellow)

simple fracture, asthma without respiratory distress, fever, hypertension, abdominal pain, client with renal stones

Non-Urgent (Green) – minor laceration, sprain or cold symptoms

THE PHILIPPINE NATIONAL RED CROSS
Community Health and Nursing Services

START (Simple Triage and Rapid Treatment)

The categories in START are:

-the deceased, who are beyond help

-the injured who could be helped by immediate transportation

-the injured with less severe injuries whose transport can be delayed

-those with minor injuries not requiring urgent care.

1st priority: Life-threatening- needs to be treated within 1-3 hours; Transport Immediately.

Example: obstruction/damage to airway, breathing disturbance (RR = 30/min or RR<10/min), Circulation disturbance (HR = 100/ min or weak pulses), altered level of consciousness, external bleeding with CVS collapse

2nd priority: Urgent- needs to be treated within 4-6 hours; Transport after Red Cases

Example: Major burns: involving hands, feet or face (excluding respiratory tract); complicated by major soft tissue trauma, spinal injuries; long bone or pelvic fractures, environmental injuries (heat/cold exposure)

3rd priority: Requires minor treatment or can be delayed, Transport after Red and Yellow

Example: Minor injuries not threatened by ABC instability, minor fractures, soft tissue injuries,minor burns

Last priority: Expectant- Dead or Non-salvageable given the available resources; Lowest transport priority

Example: Injuries so severe that survival cannot be expected even under the most ideal conditions; obviously

mortal wounds where death is certain, death or moribund state

THE TRIAGE TAG

Caring for the Deceased & Expectant Victims

Recognize the importance of family rituals and provide support to loved ones

Organ donation procedures of the health care agency need to be addressed if appropriate

Do initial care of the deceased, make sure to label the body for other members of the team to recognize

Clinical Assessment in the ER

Primary Assessment – to identify any client problem that poses an immediate or potential threat to life

E.G. – usage of ABCs

Secondary Assessment – follows primary assessment and after treatment for any problems identified

E.G. – full history taking and physical assessment

TRAUMA CARE

The Objectives

At the completion of this session you should:

Understand the priorities of trauma management

Be able to rapidly and accurately assess trauma patients needs

Be able to resuscitate and stabilize trauma patients

Know how to organize basic trauma care in your hospital/community.

Trauma in Perspective

BENEFITS

-the great distances over which casualties may have to be transported to reach

a medical facility

-the time taken for patients to reach medical care

-the absence of high-tech equipment and supplies

-the absence of skilled people to operate and service it.

PREVENTION

This depends on the location’s resources and factors such as:

culture

manpower

politics

health budget

training.

ABCDE of Trauma

The ABCDE survey (Airway, Breathing, Circulation, Disability and Exposure) is undertaken.

airway obstruction

chest injuries with breathing difficulties

severe external or internal hemorrhage

abdominal injuries.

Note: This primary survey must be performed in no more than 2–5 minutes.

Airway Management

Talk to the patient

Give oxygen (if available, via self-inflating bag or mask)

Assess airway

snoring or gurgling

stridor or abnormal breath sounds

agitation (hypoxia)

using the accessory muscles of ventilation/paradoxical chest movements

cyanosis.
need for advanced airway management
 persisting airway obstruction

penetrating neck trauma with haematoma (expanding)

apnea

hypoxia

severe head injury

chest trauma

maxillofacial injury.

There will always be people who will do this to you

But just continue to be strong, and keep moving forward.

I just wanter to let you know that even though it sometimes seems...

As if for every step we take forward, we're pushed back 10...

Just stay strong and we will get where we are destined to be..

And never forget that "Wat God has for you is for YOU"
Continue to trust God

The steps of a good and righteous man and woman are ordered by the Lord
So, order your steps in His word.
Jesus Loves you and me
Be strong!

Photos In The Middle of a Plane Crash

The world saw the disappearance of an A330 Air France during a trans Atlantic flight between Rio to Paris.

Two shots taken inside the plane before it crashed. Unbelievable!

The two photos attached were apparently taken by one of the passengers before the aircraft crashed. The photos were retrieved from the camera's memory stick. You will never get to see photos like this. In the first photo, there is a gaping hole in the fuselage through which you can see the tail plane and vertical fin of the aircraft. In the second photo, one of the passengers is being sucked out of the gaping hole.

These photos were found in a digital Casio Z750, amidst the remains. Although the camera was destroyed, the Memory Stick was recovered. Investigating the serial number of the camera, the owner was identified as Paulo G. Muller, an actor of a theatre for children known in the outskirts of Porto Alegre.. It can be imagined that he was standing during the turbulence, he managed to take these photos, just seconds after the tail loss the aircraft plunged. The structural stress probably ripped the engines away, diminishing the falling speed, protecting the electronic equipment but not unfortunately the victims. Paulo Muller leaves behind two daughters, Bruna and Beatriz.

Pain is Temporary

“Pain is temporary. It may last a minute, or an hour, or a day, or a year, but eventually it will subside and something else will take its place. If I quit, however, it lasts forever. That surrender, even the smallest act of giving up, stays with me. So when I feel like quitting, I ask myself, which would I rather live with?”
— Lance Armstrong, It’s Not About the Bike: My Journey Back to Life

Trip Log: Rancho Sta. Monica, Palawan

When I was still a kid, we used to go up this place a lot. The place is owned by the Mitras, a powerful political family in Palawan. You don't need to know people to get in. Their house simply has this breath taking view that they allow sightseeing on the grounds for free. From the area, you have a 360-degree view of the city proper, including a view of the Honda Bay.

Currently, they offer ziplines worth Php 500. If you ask me, the price is steep but there's a really fun part about this. Other than experiencing an exciting activity, you get to ride one of their horses to get back to the ranch. If you ask me, that's pretty neat by itself.

Getting inside the house though, is another story. This is where you need to know connections to get inside. After all, it is a house. So it would be awkward if people streamed inside the place day in and day out.

Inside the house, you'll see portraits of their mom and dad (left) and portraits of the good-looking boys. There are also the plaques and awards that the family has received throughout the years.

Fun fact: their dad was Ramos' opponent for presidency back in the day.

We were also able to absorb their backyard, which was still another vast area of green land overlooking the city. I was even lucky to meet the cutest dog ever!

Trip Log: Honda Bay, Palawan

First of all, I'd like to thank the readers out there (if there are any) for taking the time to browse my articles. I know my brain seems all over the place lately, but I'm back. :)

For our Honda Bay trip, we didn't actually get a agency reservation for it. Frankly, I hated the idea of following strangers around, the limited time for absorbing everything, especially the uncomfortable feeling of being around people you can't fart around.

Basically, we just dove into the waters.

ATTENTION: This part is important --- the cut-off time for the island hopping is at 2:30 in the afternoon.

It's important that you don't waste time on tours because you'd really want to savor the moment and the place, right? So you need to take very careful note regarding your time.

Some other tourists' van

We toured the city that morning so we had to do the island hopping in the afternoon. Fortunately, we arrived at 2:15 at the dock. We paid fees for the boat and the environmental taxes etc. Oh wait, scratch that. Dad paid. :D For four people, he paid Php 1200. We preferred to get the short trip because frankly, we had little time before sundown. The boatmen were instructed to have all boats docked by the port before six. For the long trip, the bill would just be around Php 2000, which is really not that bad when you think about it. There were also some forms that you had to fill up. Nothing fancy, just basic facts about you and your fellows. Other than that, we rented snorkeling gears, at a cheap price of a hundred bucks each.

If you want the whole effect (snorkeling gears, swimming shoes, and those fin thingys they use) you'd have to pay Php 300 for the whole set.

Another important tip: BUY BREAD. Lots and lots and lots. I'll explain in a few.

So we loaded the boats. Palawan has these neat, spacey boats fit to accomodate tourists. They build them so the passengers could face each other, unlike the ones that we rode in Surigao. Each passenger were instructed to wear bright orange life-vests, and we were set to go. If you're going on a long trip, it's recommended that you bring food with you, in case you'd get hungry.

Then the real fun begins.

It actually depends on what you talked to your primary boatman with. We opted to go to Pambato Reef and LuLi Island. In each stop, you need to pay a certain amount of fee, per pax. This is where things can actually get expensive. If, for example, you go to 5 different islands with 10 people. And the average fee would amount to 50-100 Php, you'd pay quite a lot. Still, the experience will be priceless. For some, it would be a once in a lifetime trip so might as well make the most of it.

Pambato Reef is actually a new attraction. They put up a floating 'kubo' in the middle of the ocean, which is awesome by the way. It has this large 'Pawikan' sitting on top. This is where they actually 'warm up' the tourists. You won't have to worry if you don't know anything about swimming, i don't too. With your trusty lifevest, your boatman leading you, and another floating device they'd make you hang into there is no way you can drown. On top of that, they have like a dozen people watching over you. All of which are ready to dive if anything goes wrong.

When I placed my 'alien-looking' mask on and saw the hidden beauty of the ocean, I screamed. Which was awkward because I had the gear on, and I was submerged in the waters. But, people heard, and I heard chuckles. :)

It was breath-taking. I was floored to say the least. To see the schools of fish so near you could touch them, is definitely worth everything you'd pay for. If you don't know, I am actually a big fish-person. I've tried a couple of times to take care of the little ones, but the city living really doesn't fit them.

The next island is the LuLi Island, short for 'Lumulubog, Lumilitaw' the tagalog terms for sinking and appearing. At high tides, the island disappears, leaving only the cottages behind. I personally like this one because we were able to do more here. First of which is the fish feeding. This is where your bread comes in. Again the boatman guides you as you snorkel and see the wonders of nature beneath you. A tip my dad gave us is to place the bread directly at your face, so that the fish nibble at you.

But, no. I didn't do it. I mean, ew.

To give you an idea, for three people (my dad didn't go feed the fish) we used three packs of bread. And that's for only a single island. So, if you're planning to go far you better go big.

Other than that, the island also has these cute picture ideas that they offer. This was my favorite detail for the whole trip: in every place we went, locals were experts on taking souvenir photos for tourists. And when I say experts, I mean SLR-techy. You'd only teach them few of the camera specifics and away they go.

Disclaimer: This shot was not in any way sponsored by SMB

After that, we found ourselves tired from all the activities and found ourselves packing to go home. :) It was definitely a fun experience, and you'll make it more special if you spend it with your loved ones.

Bringing My Heart to My Home

I am a true-blue Palawena, and I'm I am more than proud to share that fact off with anybody who's anybody. It's fun looking at different reactions when I say, "I'm from Palawan". The responses go from dull as "Oh", to shocked: "Really?!", and there will always be reactions like, "Dalhin mo naman kami dun!"

But when you're in a relationship, you just want to share every experience with your better half. It's like if you're going to enjoy something alone, you get that nagging feeling that you're just not doing it right. Even if you text him every minute of that day, guilt simply sets in.

So what better idea than to bring him to my hometown? The place I grew up in, where people saw me as the fat kid who never learned how to ride a bike.

The last week of November marked my grandmother's 88th. Of course I have to be there. I haven't attended her birthdays in such a long time and I wanted to be by her side.

When the moment came, we immediately booked a flight from Cebu Pacific's Promo Fares a month away. Of course, this presented us with a whole lot of problems. The first one was the schedule conflict. Unfortunately, Cebu Pacific's Promo Fares are non-refundable and non-transferrable. And frankly, we paid Php 6,000 for our round-trip fare. And to have it rebooked for another date would cost us Php 5,000. Which would ultimately erase the fact that we bought it on a promo fare, to spend less.

To think about it, it would be wise to get these Promo Fares if you're (a) Really really sure or (b) You spend less than 500 on it, so you won't get sad if things go south.

First of all, this event was especially special for us. It was our first plane ride together. I was extra happy that he was all giddy and stuff. Just like a toddler would be.

In Palawan, we were able to go to lots of different places together. But the thing that mattered most for me is that he was able to meet with the family. Seeing him interact with people I love, makes my heart go mushy all-over again. It's hard to explain, and I guess some people just won't understand. But, I'm pretty sure it's love.

A shot outside the window from our plane