Emergency medicine: understand triage, assessment and next steps
Emergency medicine involves acute illnesses and injuries. The immediate goal is to identify potentially life-threatening problems, assess the need for timely intervention and decide on subsequent care. This guide explains those concepts for study; an actual illness needs assessment through the appropriate service.
The most seriously unwell people need priority
Triage helps determine both urgency and the direction of care. It does not rank everyone in the order they arrive, and ambulance transport does not guarantee being seen first. The triage team considers the person’s condition and the time-sensitive nature of any treatment needed. An initial assessment may require further review as the situation changes.
In a teaching case, distinguish urgency from the eventual diagnosis. A person may need rapid attention before the cause of a problem is fully established. Triage therefore answers a different question from a final diagnostic conclusion. If someone waiting for care becomes worse, they should tell the clinical staff rather than relying on the assessment made earlier.
A clear account links the event with current findings
The history obtained by the clinician provides context for what occurred prior to presentation, when each symptom began, medicines taken, pre-existing medical conditions, etc. In addition to history, physical exam and measurements provide insight into the patient's current state. Assessment can occur alongside treatment when the condition warrants it. Due to the potential lack of information present during an initial evaluation, there will be times where the clinician cannot definitively conclude a diagnosis and/or a course of action.
Practice providing a concise summary of events, separating fact from assumption: what occurred? When did it begin? How have things changed? And, specifically, what concerns prompted you to obtain medical assistance? When you are unable to provide certain information acknowledge such. Providing a chronological series of events as opposed to a long list of unrelated symptoms without timelines supports effective communication but does not enable a layperson to develop the ability to perform emergent medical interventions.
Investigations should address the clinical question
Laboratory tests, imaging studies and other types of investigative modalities provide answers to specific questions related to the assessment. Rather than ordering laboratory tests and radiographs for every patient, only those tests identified during the assessment as being necessary to answer specific questions are ordered. Results from these investigations must be viewed within the context of the patient's symptoms, findings from examination, timeline of development and overall clinical picture. Initial results may prompt further observation/testing prior to developing an explanation for the presenting symptoms.
To assist in preparing for a written examination, consider writing what a particular investigation would likely confirm or leave uncertain. Although a reassuring result from a single investigation may address one concern, it does not eliminate all possible causes of symptoms. Similarly, identification of abnormal results in an investigation does not automatically equate to diagnosis. Ultimately, decisions regarding treatment, referral or disposition depend on the cumulative body of evidence developed during the assessment along with the individual patient's clinical condition.
Discharge needs an understandable plan
Patients may either require hospitalization or specialty consultation or may be discharged home with a treatment plan and recommendations for follow-up. Regardless of the destination, patients must receive education related to what was discovered during their evaluation, what remained unclear or uncertain, what actions are recommended for future management and when additional assistance should be sought. Recommendations must be directed toward the original assessment. The diagnosis label alone does not explain what someone should do after the visit.
In the UK, 999 services are for emergencies that threaten life. However, for less severe situations, NHS 111 services can help individuals determine the appropriate service for their concerns; local access arrangements vary throughout the UK. A study quiz cannot determine the urgency of an actual illness. Always follow guidance provided by emergency response personnel or clinicians and seek help if your condition worsens.
Check your understanding
A short quiz, with an explanation after each answer.
What is the main purpose of triage?
Go back to the part of this guide that you thought was most difficult and give a description of an example using your own words (without looking at the page). Next check your description against the example given on the page. Repeat the quiz again later. The ability to describe your rationale is far more valuable than knowing where to find an itemized correct answer on a quiz.