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Emergency Presentations 585

system to discover abnormalities (i.e. central nervous Mental Health Presentations
system, cardiovascular system, respiratory system, gastro- Patients with psychiatric problems presenting to an ED
intestinal system, etc.). 6,11,12 See also the relevant ‘system- should be triaged, assessed and treated as for other
based’ chapters.
presenting patients, with particular attention to appro-
priate initial medical assessment and management. 6,11,12
TRIAGE ASSESSMENT OF SPECIFIC Resources outlining specific mental health triage category
PATIENT GROUPS descriptors are readily available, and relate specific
While triage assessment is a complex process for a range aspects of mental health presentation with clinical
of patient presentations, some specific groups are more urgency and triage categories (see Table 22.4), including
demanding, such as mental health, paediatric and mass an outline of suggested responses, such as patient place-
casualty patients. ment requirements based on the level of risk and
urgency. 6,11-14

Practice tip Paediatric Presentations
Children presenting to the ED are assessed and assigned
If it is unclear what triage category should be assigned, the a triage category as for adults, although vital differences
patient should be allocated a higher category.
in paediatric anatomy, physiology and clinical presenta-
tions should be considered (see Chapter 25). The reli-
ance of information from parents or primary carers
and their capacity to identify deviations from normal
is important, particularly in supporting recognition of
TABLE 22.3 Aids to triage assessment often subtle indicators of serious illness in infants and
young children. Paediatric triage resources are available
Mnemonic Components to assist in identifying physiological alterations and
SOAPIE Subjective data applying the ATS based upon identified physiological
Objective data discriminators. Other important points to consider
12
Assessment (to enable formulation of a …) include:
Plan (that is …)
Implemented (and …) l children may suffer rapid decompensation due to
Evaluated (as to its success) limited physiological reserves; a short time is a
AMPLE Allergies long time in the life of a child, and may develop
Medications serious illness in a much shorter time than for an
Past medical history adult. 11,12,15
Last food and fluids ingested
Environmental factors and Events leading to l children are less able to tolerate pain in either physical
presentation or psychological terms. 11,12,15
l it is difficult to rationalise long waiting periods with
PQRST Provoking or Precipitating factors
Quality and Quantity (severity) of the symptom a child or parent of a sick child. The longer they wait,
Region/Radiation the more difficult an examination becomes. 11,12,15
Symptoms associated l parents are much less tolerant of waiting times
Time of onset and duration of episode, and for their sick child than they would be for
Treatment
themselves. 11,12,15

TABLE 22.4 Examples of a mental health triage tool 13
ATS Observation Action
1. Immediate Severe behavioural disorder with immediate l Provide continuous visual observation in safe environment
threat of dangerous violence to self or others l Ensure adequate personnel to provide restraint/detention
2. Emergency Severe behavioural disturbance with probable l Provide continuous visual observation in safe environment
risk of danger to self and others l Use defusing techniques
l Ensure adequate personnel to provide restraint/detention
3. Urgent Moderate behavioural disturbance or severe l Provide safe environment, frequent visual observations every
distress with possible danger to self and others 10 minutes
4. Semi-urgent Semi-urgent mental health problem with no l Regular visual observations at a maximum of every 30 minutes
immediate risk to self or others
5. Non-urgent No behavioural disturbance or acute distress l Regular visual sighting at a maximum of one hour intervals
with no danger to self or others