Category: Fundamentals During the triage process, individuals who most benefit from early transport should be marked as “first-out” in case an evacuation opportunity occurs. These would be victims with medical problems readily treatable, but untreatable and fatal in the field.
Category: Fundamentals Initially, all victims who are able to walk are asked to move away from the incident area. These patients are classified as green or “walking wounded,” and are reassessed after the more immediately critical patients are triaged.
Category: Fundamentals To assist in the understanding of triage techniques, it is useful to consider multiple casualty events. In such situations, personnel use triage and rapid treatment techniques that depend on assessments of respiration, perfusion and mental status.
Category: Fundamentals The goal of disaster triage is clearly different, that is, “to do the most good for the most people.” In other words, there is a shift from focus on individual patients to focus on the entire affected population.
Category: Fundamentals The term triage derives from the French verb trier, meaning “to sort.” The concept of triage was used as far back as Napoleon’s time to assign priorities to treatment of the injured when resources were limited.
Category: Fundamentals Patients with liver transplants have a higher incidence of infection than those with kidney or heart transplants, with the most common source being abdominal and biliary tract infections. Bacterial infections and sepsis are common.
Category: Fundamentals The most common electrocardiogram (ECG) abnormalities after heart transplant are incomplete right bundle branch block (RBBB) and repolarization abnormalities, although these changes are not felt to be of clinical significance.
Category: Fundamentals The transplanted heart is denervated, which causes clinically important physiologic changes. Without parasympathetic tone, the resting heart rate in a transplant patient varies from 95 to 110 beats/minute.
Category: Fundamentals Anatomic complications of solid organ transplants can be categorized into three groups: vascular, nonvascular anastomosis and complications related to surgery. These are often manifested early in the post-transplantation course.
Category: Fundamentals Transplanted organs have surgical anastomoses to a variety of structures, including vessels, bronchi, ureters, intestines and even the bladder. They are devoid of their native innervations and thus pain is an unreliable sign of underlying disease.
Category: Fundamentals Although fever can be suppressed or lessened by immunosuppressive agents such as corticosteroids and nonsteroidal anti-inflammatory drugs, most cancer patients with infection manifest fever despite the use of these agents.
Category: Fundamentals Fever in the neutropenic patient is defined as a temperature of 38.3° C (101° F) or > or a temperature of 38.0° C (100.4° F) or > during 1-2 hours. In neutropenic patients, the temperature should be measured orally or tympanically, not rectally.
Category: Fundamentals Neutropenia is defined as a neutrophil count of less than 500 cells/mL (5 × 105 cells/L), including band forms, or less than 1000 cells/mL (1 × 106 cells/L) and expected to fall to less than 500 cells/mL.
Category: Fundamentals Patients with cancer frequently have multiple immune defects, such as neutropenia and impaired function of T and B cells, induced by cancer chemotherapy or by the disease process itself, which predisposes them to infection.
Category: Fundamentals Antibodies are produced by B lymphocytes, and each B cell produces a microbe-specific antibody type. Stimulation by an antigen causes proliferation of this B cell so that large quantities of a specific circulating antibody can be produced.
