Trauma and triage in the ED.

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Today, I was assigned to be one of just two triage nurses in the emergency department (ED) waiting room. With a limited staff and nearly full department, our next wave of patients arrived. I collected health information from the patients, screened for domestic violence and suicidality, made a triage decision regarding acuity level, and assigned an ED destination based on bed availability and estimation of resources.

Then, a man was wheeled in, with a woman close behind screaming “a car ran over his legs!” I saw an open bleeding wound on his right lower leg. I brought him to the trauma room.

The woman said to me, “I don’t think I can walk anymore.” I asked her if the car hit her too, and she replied, “yes, the car hit me too.”

As a trauma nurse, I stayed to help the trauma staff with the simultaneous trauma cases. Then I went back to the waiting room.

I prioritized.

More patients arrived, seeking assistance for many different needs. Then my charge nurse came out and informed me that I was needed back in the trauma room to receive an incoming patient who had fallen down a 15-foot ravine. Nursing resources were reallocated as needed to meet the needs of our patients.

As the initial trauma evaluation identified a possible abdominal bleed, a major trauma patient arrived in the adjacent resuscitation bay with a hemorrhaging extremity wound. CT informed us that they were on hold for the major trauma. I could see that this patient was belligerent and the team was having difficulty getting him settled. I discussed this with the trauma team and we decided that my fall patient could have his scan now while they stabilized the bleeding patient.

I assessed and sorted.

I returned to the waiting room. I assessed and sorted adult and pediatric patients, high acuity and low acuity patients. More staff arrived to open additional patient care areas, providing more resources for our waiting patients. I reassured an elderly woman as we discussed her medical and psychiatric concerns and I decided on an appropriate treatment area.

An adolescent boy with a behavioral disorder who was nearly twice my size arrived in the waiting room with a caregiver and his mother. The patient had sustained a minor injury after a fall. He was agitated because of his injury and the unfamiliar environment. As I was collecting information from his mother, he lunged at me, grabbed my glasses off of my face, and threw them across the waiting room.

I cleaned my glasses and continued my triage assessment. About a half hour later, after he’d been moved to a room in the pediatric zone, I went for a quick bathroom break and noticed that my face was bleeding. The patient’s nail must have cut me as he grabbed my glasses. I irrigated my cut, returned to the waiting room, and called my next patient.

I triaged.

I approached a man who was having worsening shortness of breath after his liver transplant. As I performed a symptom analysis, he told me about his ongoing hemoptysis and night sweats. I interrupted him to inform my lobby charge nurse to prepare a room for airborne precautions and don appropriate PPE. By the time I completed my triage assessment, my charge nurse had a negative pressure room ready for the patient.

Emergency nurses face the challenge of using limited resources to meet the unpredictable needs of our patients. We are trained to rapidly evaluate and treat patients of all ages and at all levels of acuity. We expect to adapt our roles based on the needs of the department.

Today, it was my job to sort through the patients. Emergency nurses triage in order to appropriately allocate the department’s limited resources. We triage 24 hours per day, seven days per week. As I ended my shift, patients continued to arrive in our waiting room seeking care, but a night shift nurse had arrived to relieve me of my duties.

Charlotte Ahr is an ED nurse at a hospital on the West Coast.