Triage at home

The word Triage comes from the French verb trier, meaning to separate, sort, sift or select. In medicine it is used to determine how urgently you need to be treated in the light of the severity of your symptoms. Most casualties and emergency units use some sort of triage system to manage the flow of patients. Children will almost always be treated preferentially, but if you take your snotty 2 year old (with no other symptoms) to a busy emergency unit, you may very well end up waiting many hours with many unfriendly glares in your direction.

I understand that it is scary when your child is sick. When Eran recently had fever for the 5th day in a row I wanted to take him to the emergency unit just so that someone else could make sure he is really ok. I want to empower you with some tools that can help you decide when your little’s symptoms are really dangerous and need urgent care (we talk about red flag signs), and when it is ok to wait a day or two to see a doctor.

“If you say, “The Lord is my refuge,”
    and you make the Most High your dwelling,
10 no harm will overtake you,
    no disaster will come near your tent.
11 For he will command his angels concerning you
    to guard you in all your ways.”

Psalm 91:9-11

The following chart is a “triage system” for your home, listing some symptoms and signs that are red (rush to the emergency unit NOW), yellow (see a doctor at their office as soon as possible, can wait a day or maximum two if conditions does not change) or green (can visit a clinic, nurse or your GP at a convenient time). Below the chart I will explain how to identify some of the signs, or add links to give you examples of the symptoms.

PLEASE NOTE:

This is a very generalized chart that covers most of the common danger signs and symptoms and gives very broad advice. If you are at any stage worried about your child or your child has symptoms not mentioned here, please contact your doctor ASAP for more advice.

“He will call on me, and I will answer him;
    I will be with him in trouble,
    I will deliver him and honor him.
16 With long life I will satisfy him
    and show him my salvation.”

Psalm 91:15-16
home-triage

 You can download this chart as a PDF to stick in your first aid kit: Home triage chart

*Lethargia: Your child seems sleepy, listless and difficult to wake up. Not interested in their surroundings, not alert, does not eat / talk / play, too weak to even cry. It is usually due to a decrease in glucose / oxygen / blood flow to the brain and should always be taken seriously.

*Convulsions: Click here and here to see two short videos of convulsions in kids and some tips on how to manage them. If it continues for more than 5min, it is classified RED.

*Non-blanching rash: This reddish-purple rash is identified by pressing a glass against it. If it does not disappear for a few seconds, it could be due to meningitis or sepsis.

*Cyanosis: Could affect the fingers and toes only (shows reduced circulation of blood), or it could affect the lips and tongue (a sign of low oxygen in the blood). The second type is much more worrying and should be treated immediately.

*Breathing rate: It is easy to count your child’s breathing rate by looking at the spot just below the ribs. Count for a full minute because breathing can be uneven. Click here for a video to see a child that is using extra muscles to breathe – another sign of trouble.

*Abnormal breathing sounds: Click to hear wheezing (narrowing of the airways in the lungs eg asthma, bronchiolitis, foreign object in the lungs) and stridor (narrowing of the airways above the lungs eg croup, foreign object in upper airways)

*Dehydation: Your baby may have no tears when crying, a dry mouth with no saliva, a sunken fontanelle (soft spot on baby’s head), sunken eyes (eyes seem deep set) or be very thirsty or irritable. Another sign we look for is a slow skin pinch, where the skin pinched between your fingers over the belly pulls back very slowly. Your child may also urinate less. Any of these signs could indicate that your child is dehydrated and should be taken seriously.

*Anaphylaxis: This is a life-threatening form of an allergic reaction. It usually happens when your child is exposed to an allergen for the second time, as the body has then prepared a response after the first exposure. It could happen with any allergen, but bee-stings, nuts and fish are the most common offenders. The allergic reaction (starts with a rash / hives) and progresses to show new symptoms as listed above. The massive immune response causes a drop in blood pressure as well as swelling of the airways and these children needs to be treated with an intra-muscular injection of Adrenalin ASAP!

*Sepsis: When a viral or bacterial (or rarely fungal) infection spreads from the site of infection (throat, ears, urine) to the bloodstream, there will be a massive immune response which causes havoc in your little’s body. Heart rate shoots up, blood pressure drops, they breathe faster to try to keep up with the oxygen demand. This could be life threatening and needs to be treated with the appropriate fluids and antibiotics ASAP.

“He will cover you with his feathers,
    and under his wings you will find refuge;
    his faithfulness will be your shield and rampart.”

Psalm 91:4

Let me know if you find this chart and explanations useful. I hope it will help with those middle-of-the-night decisions and get the sickest littles where they need to be. Give your kids an extra cuddle tonight if they do not fall into the red column and be thankful for another day with them!

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