Emergency Care & Triage: Definitions, Priorities, and Critical Conditions

**Emergency care definition

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Collaborative, holistic care involving patient + family + significant others

**Priorities in emergency care

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ABCDE: Airway, Breathing, Circulation, Disability (GCS/AVPU), Exposure

**Triage categories (ESI)

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ESI 1 = immediate provider

ESI 2 = needs multiple resources + abnormal VS

ESI 3 = needs multiple resources

ESI 4 = one resource

ESI 5 = no resources

**Emergent triage level definition

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Life-threatening condition requiring immediate intervention

**Urgent triage level definition

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Serious but not life-threatening; treated soon

**Non-urgent triage level definition

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Minor illness; delayed care acceptable

**Heat stroke signs

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Hot dry skin, temp > 102.5°F, altered LOC, tachycardia, hypotension

**Heat stroke management

Rapid cooling to 102°F; stop cooling at 100.4°F; IV fluids; ice packs to neck/groin/axillae

**Frostbite appearance

Hard, cold, white/mottled, insensate

**Frostbite treatment

Rapid but controlled rewarming (98.6-104°F baths), analgesics, elevate, NO massage

**Hypothermia definition

Core temp < 95°F

**Hypothermia management

Mild: external rewarming

Severe: internal rewarming (warm fluids, warmed O2, peritoneal lavage, bypass)

**General poisoning priorities

Remove/inactivate agent, maintain airway, support vital organs, antidote if available

**Ingested poison management

NO inducing vomiting, gastric lavage, activated charcoal, cathartics

**Carbon monoxide hallmark

Pulse ox FALSE NORMAL; skin not reliable; treat with 100% O2

**Food poisoning management

ABC's, treat dehydration, electrolytes, antiemetics

**Acute alcohol intoxication assessment priority

Rule out head injury, hypoglycemia, hypoxia, hypovolemia

**Alcohol withdrawal signs

Tremors, agitation, anxiety, hallucinations, tachycardia, HTN; risk for delirium tremens

**Tension pneumothorax signs

Tracheal deviation, absent breath sounds, hypotension, distended neck veins

**Open pneumothorax initial step

Apply occlusive dressing taped on 3 sides

**Chest tube: bubbling in water seal

Intermittent = normal

Continuous = air leak

**Chest tube dislodged from patient

Cover with sterile occlusive dressing taped on 3 sides, notify provider

**Chest tube disconnected from system

Place in sterile water immediately to create water seal

**ABG criteria for acute respiratory failure

PaO₂ < 60

PaCO₂ > 50

pH < 7.35

**ARDS hallmark

Refractory hypoxemia (O₂ does not improve with oxygen therapy)

**ARDS X-ray finding

Bilateral white-out infiltrates

**ARDS breath sounds

Crackles, decreased air movement

**ARDS management

Intubation, mechanical ventilation, PEEP, prone positioning, fluid support, sedation/paralytics

**Classic PE symptoms

Sudden dyspnea, chest pain, tachycardia, anxiety, hemoptysis

**Best imaging test for PE

CT angiography (MDCTA)

**PE medications

Anticoagulants (heparin)

Thrombolytics (massive PE only)

**IVC filter use

Recurrent PE or inability to anticoagulate

**Volume control mode

Delivers preset tidal volume; pressure varies

**Pressure control mode

Delivers preset pressure; tidal volume varies

**SIMV purpose

Allows spontaneous breathing between mandatory breaths

**Pressure support / CPAP use

Weaning + spontaneous breathing trials

**PEEP purpose

Keeps alveoli open; improves oxygenation

**High PEEP risk

Barotrauma, pneumothorax

**High pressure alarm causes

Biting tube, kinked tubing, mucus plug, bronchospasm

**Low pressure alarm causes

Disconnection, leak, cuff rupture

**NIPPV contraindications

Facial trauma, vomiting, decreased LOC, excessive secretions

**Burn depth for pink + blisters + very painful

Partial-thickness (2nd degree)

**Electrical burn priority

Cardiac monitoring (dysrhythmias)

**Rule of nines: anterior chest/abdomen

18%

**Parkland formula

2-4 mL × kg × TBSA% (LR)

Half in first 8 hours from TIME OF BURN

**Adequate urine output for burns

0.5-1 mL/kg/hr

**Older adult burn risks

Slower healing, less elasticity, higher infection risk

**Prerenal AKI cause

Decreased perfusion (shock, dehydration)

**Intrarenal AKI cause

Acute tubular necrosis, nephrotoxins

**Postrenal AKI cause

Obstruction (stones, BPH)

**Kidney stone hallmark symptom

Severe flank pain radiating to groin

**Stages of shock

Compensatory → Progressive → Irreversible

**Hypovolemic shock cause

Volume loss (hemorrhage, burns)

**Cardiogenic shock cause

Pump failure (MI)

**Neurogenic shock signs

Hypotension + bradycardia

**Septic shock hallmark

Refractory hypotension despite fluids

**DIC hallmark labs

Decreased platelets, increased D-dimer, prolonged PT/PTT

**Appendicitis classic finding

RLQ pain (McBurney's point), rebound tenderness

**Peritonitis signs

Rigid board-like abdomen, fever, rebound tenderness

**Liver failure hallmark

Jaundice, ascites, asterixis, elevated ammonia

**Acute cholecystitis pain location

RUQ radiating to right shoulder

**Acute pancreatitis hallmark

Epigastric pain radiating to back, ↑ lipase

**DKA hallmark

Kussmaul respirations, fruity breath, ketones, pH < 7.3

**HHS hallmark

EXTREME hyperglycemia, NO ketones, severe dehydration

**DI urine output

High output, dilute urine (low specific gravity)

**SIADH urine output

Low output, concentrated urine

**Spinal shock definition

Temporary loss of all reflexes/sensation below injury

**Neurogenic shock signs

Bradycardia + hypotension + warm/dry skin

**Autonomic dysreflexia triggers

Full bladder, fecal impaction, tight clothing

**Autonomic dysreflexia treatment

Sit up, remove trigger, treat BP

**5 P's neurovascular check

Pain, Pallor, Pulselessness, Paresthesia, Paralysis

**Compartment syndrome hallmark

Pain out of proportion + pain on passive stretch

**Fat embolism signs

Confusion, petechiae, hypoxia

**Increased ICP signs

Cushing's triad: HTN, bradycardia, irregular respirations

**Epidural hematoma hallmark

Lucid interval then rapid deterioration

**Basilar skull fracture signs

Raccoon eyes, Battle's sign, CSF leak