triage
DESCRIPTION
TRANSCRIPT
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TRIAGE
Dr. Fredy PINTO SamanezMedico Anestesiologo
Hospital Naval
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PRIORIZAR
TRIAGE = TRIERE
CATEGORIZARSELECCIONAR
CLASIFICAR
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TRIAGE
1792
Barón
Jean Dominique Larrey
1792
Barón
Jean Dominique Larrey
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TIEMPO DE RESCATE
PRENAPOLEONICA TERMINO DEL COMBATE
NAPOLEONICA DURANTE EL COMBATE
I GUERRA MUNDIAL 18 Hrs. 87 %II GUERRA MUNDIAL 7 Hrs. 58 %GUERRA DE KOREA 3 Hrs. 24 %GUERRA DE VIETNAM 80 min. 17 %GUERRA DEL GOLFO 10 min. 10 %
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TRIAGE
SELECCIÓN DE PACIENTES SEGÚN:
GRAVEDAD,
PRIORIDAD DE ATENCION (ABC)
RECURSOS DISPONIBLES
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NULA Vivirán aún sin tratamiento
. Morirán aún con tratamiento
PRIORIDAD
MAXIMA Pacientes que vivirán
sólo si son tratados.
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90 % DE TRAUMATIZADOS
NO REQUIEREN CENTRO DE TRAUMA
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REGLAS DEL TRIAGE
ETIQUETAJE
ESTABILIZACION
EVACUACION
3E
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Oficial de Triage
Acción Médico legal.Personal entrenado.Condiciones:
Salud óptima Control de stress Destreza manual Condición de líder.
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TIPOS DE TRIAGE
INICIAL : ZONA DE IMPACTO
SECUNDARIO : P. M. A.
HOSPITALARIO : HOSPITAL
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TRIAGE INICIALMETODOS
M.R.C.C.Método Rápido de Clasificación en CatástrofesMarcha Respiración Circulación Conciencia
S.T.A.R.T.Simple Triage And Rapid TreatmentTriage Simple Y Tratamiento Rápido
M:D:A: ISRAELMagen David Adom - Estrella Roja de David
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TRIAGE
CLASIFICACION
BIPOLAR
TRIPOLAR
TETRAPOLAR
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TRIAGE BIPOLAR
SELECCIÓN SEGÚN: Rapidez, Riesgo y Oportunidad
VIVO MUERTO
CAMINA NO CAMINA
CONCIENTE INCONCIENTE
USO EN LA ZONA DE IMPACTO. MDA
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TERRORISMO
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Explotaron10 Bombas
Mas de 198 muertos
Mas de 1400 heridos
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ROJO : Atención inmediataAmarillo : Atención secundariaVerde : Atención diferidaNegro : Sin atención
USO EN EL ZONA CERO Y PMA
TRIAGE TETRAPOLAR
CATEGORIZACIÓN CON COLORES :0MS
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TRIAGE INICIAL CARACTERÍSTICAS
Se realiza en la zona de impacto
Personal no médico entrenado
Clasifica con cintas, pintura, autoadhesivos, etc.
Evalúa constantes fisiológicas vitales: A-B-C-D• Respiración - Circulación - Conciencia
Trata rápidamente según el A-B-C• Cánula Orofaríngea - Venda Compresiva
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TRIAGE INICIAL S.T.A.R.T
Simple Triage And Rapid TreatmentSimple Triage Al Rápido Tratamiento
1984
Memorial Hoag Hospital Presbyterian
Bomberos de New Port Beach California
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TRIAGE INICIAL S.T.A.R.T
PASO 1
Retirar a todas las víctimas que caminan
A-B-C-D Sin alteraciones
VERDES
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TRIAGE INICIAL S.T.A.R.T
PASO 2.- Evalúe A-B.- Respira? NO: Despeje la vía aérea manualmente
»Si: Cánula orofaríngea: ROJO»No: NEGRO
SI: > 30 x min: ROJO SI < 30 X min: Evalúe CIRCULACION
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TRIAGE INICIAL S.T.A.R.T
PASO 3.- Evalúe C: CIRCULACION Llene Capilar > 2 seg Pulso Radial Ausente
• SI: Control de hemorragia ROJO– Venda triangular
• NO: Evalúe CONCIENCIA
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TRIAGE INICIAL S.T.A.R.T
PASO 4.- Evalúe D CONCIENCIA.
CUMPLE ORDENES SIMPLES?
• NO ROJO
• SI AMARILLO
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TRIAGE INICIAL S.T.A.R.T
A-B-C-D. ALTERADOS: ROJO
A-B-C-D. NORMAL, NO CAMINAN AMARILLO
A-B-C-D. NORMAL Y CAMINAN VERDE
A-B-C-D. SIN RESPUESTA NEGRO
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START Triage Algorithm
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TRIAGE SECUNDARIO
CARACTERÍSTICAS Se realiza en el Puesto Médico Avanzado PMA Personal médico entrenado Clasifica con Tarjetas de Triage OMS Evalúa:
• Signos vitales - Lesiones Anatómicas - Cinemática Realiza Procedimientos de Reanimación Avanzada Una vez estabilizado decide su EVACUACION
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TRIAGE SECUNDARIO Puntuación de traumatismo Revisada (RTS)
ECG PAS FR Valor codificado
13- 15 >89 10-29 4
9- 12 76-89 >29 3
6- 8 50-75 6-9 2
4- 5 1-49 1-5 1
3 0 0 0
RTS=0.9368GCS+0.7326PAS+0.2908FR
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RTS y Sobrevida.RTS Probabilidad de
Supervivencia12 98-99
11 93-96
10 60-75
9 40-59
8 26-40
7 15-20
5- 6 <10
1- 4 0
Revised Trauma Score (RTS) GCS, presión arterial sistólica y frecuencia respiratoria.Resultado ≤ 11: requiere SVA.
Fuente: Adaptada de González L, Jiménez M, Herrera A, Barrios Z. Guía de Intervenciónde Enfermería Basada en la Evidencia. Guía 7 Politraumatizados; 23, 1998.
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Tarjetas Triage
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DIFERENCIAS ENTRE EL 1º Y EL 2º TRIAGE
PRIMER TRIAGE SEGUNDO TRIAGE
Objetivo Atención Médica Evacuación
Fundamento Funcional Lesional o Mixto
Complejidad Sencillo Complejo
Tiempo < 1 Minuto > 1 Minuto
Responsable Personal Adiestrado Médico, PR
Precisión Falla por Exceso Gran Precisión
Lugar Zona de impacto PMA
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