加拿大分诊指南是否确定肿瘤紧急情况的紧迫性

Anas Alsharawneh, Joy Maddigan
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引用次数: 1

摘要

背景:分诊在急诊科(ED)起着关键的作用,因为访问量是不可预测的。所有急诊科病人都经过分类,以确保有紧急或危及生命的情况的病人立即得到治疗,而其他情况较稳定的病人则可以安全等待。目的:研究加拿大分诊和敏锐度分级(CTAS)指南,以确定是否可以使用CTAS指南适当地优先考虑肿瘤紧急情况的紧迫性。方法:我们使用交互式计算机化CTAS工具“面向投诉的分诊”(COT 2012)对选定的肿瘤急症进行分诊;上腔静脉综合征,心包填塞,肿瘤溶解综合征,发热性中性粒细胞减少症。结果:与许多其他急诊科患者相比,癌症患者的视力更高。然而,大多数肿瘤紧急情况可能是微妙的和非特异性的。需要加强CTAS指南,以更好地反映这些危及生命的疾病的紧迫性。结论:尽管已经实施了修订,并且CTAS工具的可靠性有所提高,但指南的设计是通用的,不能解决所有健康状况。发热性中性粒细胞减少症是一个很好的例子,在分诊时需要额外的支持来准确地确定病人的健康状况。了解这些紧急情况的体征和症状将使分诊护士能够准确区分不同主诉的紧迫性。正规的教育,准备分诊护士更好地了解症状表现的复杂性和需要的护理不同的肿瘤紧急情况的病人是必不可少的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Do the Canadian Triage Guidelines Identify the Urgency of Oncological Emergencies
Background: Triage in an emergency department (ED) plays a pivotal role as the volume of ED visitors is unpredictable. All ED patients are triaged to make sure that patients with urgent or life-threatening conditions are seen immediately while others with more stable conditions are safe to wait. Purpose: To examine the Canadian Triage and Acuity Scale (CTAS) guidelines to determine if the urgency of oncological emergencies can be prioritized appropriately using the CTAS guidelines. Methods: We used the Complaint Oriented Triage (COT 2012), which is an interactive computerized CTAS tool, to triage select oncological emergencies; superior vena cava syndrome, cardiac tamponade, tumor lysis syndrome, and febrile neutropenia. Results: Patients with cancer have a higher acuity compared to many other ED patients. However, most of the oncological emergencies can be subtle and nonspecific. The CTAS guidelines need to be strengthened to better represent the urgency of these life-threatening conditions. Conclusion: Although revisions have been implemented and the reliability of the CTAS tool has improved, the guidelines are designed to be generic and cannot address every health situation. Febrile neutropenia is an excellent example of the additional supports needed at triage to accurately determine the patient’s health status. Knowledge of the signs and symptoms of these emergencies will enable triage nurses to accurately differentiate the urgency of the different presenting complaints. Formalized education that prepares triage nurses to better understand the complexity of the symptom presentation and the needed care for patients with different oncological emergencies is essential.
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