d SECTION 2 bk a Answers to Triage Scenarios Drege egaay concept of triage and encourage the students to reason through their choices rather than to arrive at a particular correct answer. There may be several sea also hand out these solutions tothe triage se-_ right answers for @ particular scenaria give specific doar cane end of the course. The most important local resources or twists that the faculty may intro aspect ofthe triage scenarios isto emphasize the duce and dlscuss. “The following suggested answers to the ATLS Tri> age Scenarios should be on hand during the course as a reference for the Course Director. ATLS sites404 SECTION 2 m Student Course Faculty Manual | Nee ese LCL Gas Explosion in the Gymnasium INSTRUCTOR GUIDELINE: The instructor should emphasize that priorities of care are based on rapid visual and auditory assessment and evaluation of patients’ symptoms. After identifying the problem, the student should establish the order in which patients should be treated (triage by priority) and describe simple basic resuscitative efforts, SCENARIO: You are surnmoned to @ triage area at construction site where 5 workers are injured in 2a gas explosion during the renovation of a gymnasium ceiling. You quickly survey the situation and determine that the patients’ concitions are as folows: PATIENT AA young man is screaming, "Please help me, my leg is kiling me!” PATIENT B—A young woman has cyanosis and tachypnea and is breathing very noisily. PATIENT C—A 50-year-old man is ling in @ pool of blood with his let trouser leg soaked in blood. PATIENT DA young man is lying face down on a stretcher and not moving, PATIENT E—A young man is swearing and shouting that someone should help him or he will call his lawyer. Questions and Response Key for Students’ Response 4. Foreach patient, what is the primary problem requiring treatment? ‘The students) should indicate that managernent priorities could be based on information gleaned by surveying all the victims from a distance. the student indicates that he or she needs to @- ‘amine each of the patients indhdualy before making a decision, the group should discuss this fesponse, The diection of the discussion shoul indicate that while information f being obtained ‘ona particular patient, another patient might de from a more serious injury. Als, the time taken te gather detalled information on ll the patients before establishing priorities based on that infomation could lead to disastrous results. If there is doubt as to which one of these patients is most severely injured, based on the avalable information, the decsion must be made to proceed ‘with the best information available at the time. ‘The instructor should then provide information that coud be obtained by surveying the situation from a distance, as follows: PATIENT Aisa young man screaming, “Please help me, my legis king met” ‘The patient has a probable fracture/dislocation of the lower extremity.) PATIENT B appears to have cyanos' and tachypnea and is breathing very Nosy {This patient likely has a compromised airway.) PATIENT Cis a 50-year-old man Wing in a poo! of blood wit his lft trouser leg soaked in biood, {This patient has potential blood loss.) PATIENT Dis ving face down on a stretcher and not moving (Ths patient may be comatose, dead, or havea spine injury) PATIENT is sweating and shouting that someone shoul help hi or he lc i aye. (6 this patient hemodynamically normal?)APPENDIX J m Answers to Triage Scenarios 405 Triage Scenario | (continued) Crees RRO UCL ~The instructor should ear expzin that all ofthe previously outined information could be obtained ‘vthout actual examining ary ofthese patents in deta and that, based on this information, @ wage eosin could be made. Te instructor may ask “Suppose you are in doubt as to which patient eres severely injured. How should you respond?” Students should be prompted to respond thatthe decsion must be made to proceed onthe basis ofthe best information avaible atthe time. sased on the information obtained by surveying the patient from a distance, the students are then eced to triage the veims and give the rationale for their choices, The convergent ot divergent mode! rmay be used here to facitate the discussions 2 Establish your patient priorities for further evaluation by placing 2 number (1 through 5; with 1 being the highest priority and 5 being the lowest) n the space ext 0 each patient letter. 4 Patient A 1 Patient 8 Patient C ues zl Patient D 5 Patient E Briefly outline your rationale for prioritizing these patients in this manner: Fre eaructor leads the discussion by asking the students to give the rationale for thelr prot Parerte these anewers are dkcissed among the students Atthe end ofthe discussion the students should arrive at the following priorities: PRIORITY 1—PATIENT B (AIRWAY COMPROMISE) Fatianolor The patient apparent isnot taking, Het respiratory efforts are api and ther is clinical Soe eof an obsruted alway (oreatting nobly). The canosé is addtional information Su porting respiratory compromise. PRIORITY 2—PATIENT D (COMAVSPINE INJURYIDEAD?) rar ut the patent bang face down and net moving, one must assure Wat te 0 se = ore eas 2 apne jury. o i ead, Had the patet been awake and cape of Taare & caption woud Rely have been asured. The ABCOES must be asase with the concem for altered level of consciousness and spinal inary. NOTE: Patients @ and D may be interchanged as Priority 1 and 2, and Bow my be considered high priory, However the rationale must be given by the student “for example, Patient D may hhave a major airway problem as well. PRIORITY 3~PATIENT C (BLOOD LOSS) eae on the bas of the nforation theres ear evidence that Ne Pater has blood loss. The Sr od Wes and wees continuing are nat kw, The patent's |ABCDES must be assessed to determine the extent ofthe problem NOTE: The next2 patients may be considered low priority: (Continued)