Earlier this week we invited you to play triage nurse at Sunnybrook Health Sciences Centre in Toronto. We gave you four patient scenarios and asked you to tell us which one should be seen first by a doctor and why.
More than 30 readers answered the survey on the article page and an additional 75 on The Globe’s Facebook page. Thanks for participating and kudos to Brian357, Shane Nordon and Fundy and many others who got it right.
- A man complaining of chest pains and shortness of breath following a long airplane flight.
- A young woman with a painful sprained ankle.
- A middle-aged man with a headache, blurred vision and an inability to use his right arm.
- A senior man who’d shot himself in the hand with a nail gun.
We asked Ray Howald R.N. to assess our patients and determine the order in which they should be seen by a doctor. A registered nurse for more than 15 years, he works at the Emergency Department at Sunnybrook Health Science Centre as a clinical nurse educator. His job involves the orientation of new staff and the ongoing education of existing staff, “keeping them up to speed with current practice issues and changes in treatment and management related to patients we see in the Emergency Department.”
Here’s the order in which Howald triaged our patients:
If you guessed the potential stroke victim should be seen first, you are correct! The 50-year-old male patient should be admitted and assigned a bed. The sudden onset of his headache, blurred vision, and difficulties in speaking and moving his right arm are symptoms of an acute stroke. His wife made the correct decision in taking him to the emergency department, although she might have considered calling 911. Because he arrived at the hospital within 4.5 hours of the onset of his symptoms, he is a candidate for the “clot busting” medication Tenectaplase. It can reverse the symptoms of his stroke, if given in a timely manner.
The second patient to be seen is the 30-year-old male complaining of chest pain and shortness of breath. His breathing problems are at odds with his general good health, but the fact that he has recently returned from a long flight from Australia is worrying. He may have fallen victim to what is called economy class syndrome. On long flights, especially for passengers sitting in cramped seats, blood flow can slow down particularly in the lower legs. Up to 5 per cent of travellers will develop blood clots or deep-vein thrombosis, which can lead to swelling and even death, if the clot moves to the lung, the heart or the brain.
The 25-year-old female with the ankle injury will be seen next. She has no obvious signs of a broken bone, but she is in a lot of pain. She ranked it as 8/10 on the Likert (pain) Scale. Pain is a very subjective measure. We have all heard tales of women sailing through labour and delivery with smiles on their faces and no pain medication, or stalwart souls who have walked through the bush on broken bones. Maybe this patient was like that, or maybe she was super-sensitive to pain. The only way to find out, is to have doctors assess her injury.
The last of our four patients to be seen is the 65-year-old male who accidentally shot himself in the hand with a nail gun. He had treated himself by pulling out the nail and slapping a bandage on his hand. Fortunately, he followed his wife’s advice and headed, with the nail, to the emergency department. She was right. He did need immediate attention, but he could have gone to a walk in clinic instead of the ER. Too bad his wife didn’t remind him to take his immunization card, which could have told doctors when he last had a Tetanus shot. Every 10 years is the practice, but because the ER doctors didn’t know whether the nail was rusty or the last time the patient had been given a Tetanus shot, they gave him an injection anyway, to be on the safe side.
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