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HOW TO TRIAGE A PATIENT

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(1)HOW TO TRIAGE A PATIENT We have all had to deal with a patient who is calling or has walked into the clinic with an eye emergency. How do you figure out if it is actually an emergency? How do you know when to book them in for an appointment? Should they be seen today? Or can the appointment wait for tomorrow or the next available appointment time. We never want to unnecessarily panic a patient about an eye emergency either. This document will go over how to correctly triage a patient with an eye emergency and will provide a guideline for when to book the patient for an appointment.. ASKING THE RIGHT QUESTIONS Asking the right questions can help you determine what a patients needs are and how to best accommodate them. Take a look at the Triage Questions page of this document, if you utilize this form and a patient answers “Yes” to any of the questions in RED then they require an appointment at some time that day if not as soon as possible. EYE CONDITIONS There are many reasons that a patient could call into the clinic claiming that they have an eye emergency. Here is a listing and brief description of the most common reasons that a patient will call. IMPORTANT: Please remember to check with your doctor if you are unsure whether a patient requires an emergent appointment. Sometimes the clinic location or doctor availability can play a role in how to deal with eye emergencies, in these cases always check with your doctor before booking an appointment. Dilated Pupil or Pupil Size Disparity Summary: 1. If after recent trauma, refer to their primary care physician or to the Emergency Room. 2. If longstanding, or no loss of vision, schedule at next available time slot. 3. If accompanied by vision loss or diplopia, see that day or refer. Lid Bumps and Lumps Summary: Schedule patient at next available appointment unless he/she is in pain. Ptosis or “Droopy Lid” Summary: Schedule at the next available time, unless other conditions such as vision loss or pain are present. Itching Summary: 1. Assure patient that itching is not an emergency. 2. Schedule as soon as schedule will allow. Flashes Summary: 1. See patient on same day for a dilated exam. 2. If it’s not possible to see the patient, refer to someone who can on that same day. Floaters Summary: 1. See patient on same day for a dilated exam. 2. If it’s not possible to see the patient, refer to someone who can on that same day. Pain Summary: 1. Attempt to determine how much pain a person is in. 2. See patient the same day if pain is moderate to severe, or if accompanied by vision loss. 3. Ask your Doctor if you are unsure. FYidoctors. |. Triaging a Patient. |. Version 1: Last Updated May 4, 2018 page 1.

(2) Eyelid Eyelid Twitching Twitching Summary: Summary: 1. Reassure 1. Reassure patient patient that that it it is is not not an an urgency. urgency. 2. Schedule at the next available appointment. 2. Schedule at the next available appointment. White White Pupil Pupil Summary: Summary: 1. Determine 1. Determine age age of of patient. patient. 2. 2. Determine Determine if if there there is is sudden sudden vision vision loss. loss. 3. In cases of children or elderly with sudden 3. In cases of children or elderly with sudden onset onset of of vision vision loss, loss, see see them them the the same same day. day. Decreased Decreased or or Distorted Distorted Vision Vision Summary: Summary: 1. If acute, see patient that same 1. If acute, see patient that same day. day. 2. 2. Consult Consult your your Doctor Doctor in in questionable questionable cases. cases. Glare Glare // Haloes Haloes // Light Light Sensitivity Sensitivity // Photophobia Photophobia Summary: Summary: 1. 1. If If the the complaint complaint is is severe, severe, there there is is vision vision loss, loss, or or the the presentation presentation is is acute, acute, the the patient patient should should be be seen seen or or referred referred the same day for evaluation. the same day for evaluation. 2. 2. If If the the patient patient has has had had recent recent surgery, surgery, they they need need to to be be seen seen the the same same day. day. 3. 3. If If neither neither of of the the above above two two conditions conditions apply, apply, schedule schedule at at the the next next available available time time slot. slot. Discharge/Tearing Discharge/Tearing Summary: Summary: 1. 1. Ask Ask the the patient patient –– xx Whether Whether it’s it’s mucous mucous or or watery. watery. xx If If it it is is painful. painful. xx If If there there has has been been vision vision loss. loss. xx If If there there is is severe severe mucous mucous discharge, discharge, pain, pain, or or vision vision loss, loss, see see the the patient patient that that day. day. 2. If none of the above symptoms are present, see at next available time. 2. If none of the above symptoms are present, see at next available time. Corneal Corneal // Conjunctival Conjunctival Abrasion Abrasion Summary: Summary: Have patient come in on same day. Have patient come in on same day. Foreign Foreign Body Body // Penetrating Penetrating Trauma Trauma Summary: Summary: 1. Attempt to determine the nature 1. Attempt to determine the nature of of the the injury injury and and whether whether it it is is penetrating penetrating or or not. not. 2. 2. If If the the injury injury is is definitely definitely severe severe or or penetrating, penetrating, refer refer to to an an ocular ocular surgical surgical center center or or the the Emergency Emergency Room. Room. 3. Make sure to instruct the patient, or those present, not to remove the object. 3. Make sure to instruct the patient, or those present, not to remove the object. 4. 4. If If there there is is no no penetration, penetration, see see the the patient patient on on the the same same day. day. Welder’s Welder’s Flash Flash Summary: Summary: See See patient patient on on same same day, day, or or refer. refer. Chemical Chemical Splash Splash Summary: Summary: 1. whomever is to copiously with water for minutes and take patient immediately Minor ocular or facial chemical splashes should be seen e.g. Hydrogen solution but any to 1. Instruct Instruct whomever is able able to irrigate irrigate copiously with watersame for 15 15day minutes and then thencontact take the thelens patient immediately to the Emergency Room for further evaluation and care. significant ocular or facial splash should be forwarded to ER and/or the ophthalmologist on call immediately. the Emergency Room for further evaluation and care. Red Red or or “Bleeding” “Bleeding” Eye Eye Summary: Summary: 1. Ask the patient 1. Ask the patient if if blood blood is is actually actually coming coming out out from from the the eye eye (can (can it it be be collected collected on on aa tissue?). tissue?). 2. Ask about discharge, pain, nausea, etc. 2. Ask about discharge, pain, nausea, etc. 3. See See patient patient same same day day if if any any of of the the above above symptoms symptoms are are present. present. 3. 4. About the only time you would not need to see a patient on the the same same day day is is if if they they complain complain of of aa “red “red spot spot on on 4. About the only time you would not need to see a patient on the white part of their eye” and there was no pain or loss of vision. the white part of their eye” and there was no pain or loss of vision. FYidoctors FYidoctors. ||. Triaging a Patient Triaging a Patient. ||. Version 1: Last Updated May 4, 2018 page 2 Version 1: Last Updated May 4, 2018 page 2.

(3) Lid Swelling Summary: 1. Determine if it is painful or not. 2. If it is painful, see on the same day. 3. If it is not painful, schedule for next available appointment Burning Eyes Summary: 1. Ask patient – x About time of onset. x To grade severity of burning x If mucous discharge is also present. x If vision is affected. 2. See patient on the same day if burning is severe, discharge is present, or vision is decreased. 3. Schedule patient for next available appointment if none of the above conditions apply. 4. Consult your Doctor if you are uncertain. Diplopia Summary: 1. If diplopia is of recent onset and binocular, see as soon as possible. 2. If diplopia is longstanding, see at next available appointment. 3. If diplopia is monocular and there is a history of macular degeneration, see within 1 -2 days. 4. Do not dilate patients prior to the Doctor seeing them in cases of binocular diplopia. Blunt Trauma Summary: See patient on same day for a dilated exam or refer. Headache: Warning Symptoms and Signs of a Serious Problem x Scalp Tenderness x Fever x Neurological signs x Decreased vision x Rapid weight loss x Nausea x Altered behaviour. x x x x x x. Pain with chewing Stiff neck History of trauma or brain surgery Headaches that wake person from sleep Headaches in the same location time after time Headaches that do not respond to normal medications. Headache Summary: 1. Try, if possible, to determine the severity of the headache, given the above guideline. 2. See or refer on the same day if the condition is potentially severe. 3. Ask your Doctor in questionable cases.. FYidoctors. |. Triaging a Patient. |. Version 1: Last Updated May 4, 2018 page 3.

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(59) Condition. Symptoms. Non-urgent Urgent - Soon. Urgent Today. EMERGENCY! EMERGENCY!. See them Refer them to Next the closest See at earliest Right Away See within 48 available convenience or refer them Emergency hours to someone appointment Today! Room or who can! Hospital LIDS Bumps and Lumps Ptosis Twitching Swelling PUPILS Pupil size disparity. White Pupils. VISUAL Flashes Floaters. Bumps and or lumps forming on the eyelid (inside or out) Accompanied by pain Drooping lids Accompanied by pain or vision loss Twitching of eyelid (upper or lower) Swelling of the eyelids Accompanied by pain One pupil is larger or smaller than the other one - longstanding Due to recent trauma Accompanied by pain or vision loss Elderly patient Accompanied by sudden vision loss Child presenting with white pupil. X X X X X X X X X X X X X. New onset of flashing lights Sudden onset or drastic changes of floaters in vision Accompanied by flashes. Decreased or Sudden onset distorted vision Over a period of days Over a period of weeks or longer Severe with sudden onset or vision Light Sensitivity loss Recent surgery If neither of the above Halos and glare around lights Diplopia (double Longstanding vision) Persistant Intermittent Any voluntary control over it? Sudden onset History of Macular degeneration Binocular Monocular Cloudy Veil Curtain rising or falling in front of vision. X X X X X X X X X X X X X X X X X X X X.

(60) Condition. Symptoms. Non-urgent Urgent - Soon. Urgent Today. EMERGENCY! EMERGENCY!. See them Refer them to Next the closest See at earliest Right Away See within 48 available convenience or refer them Emergency hours to someone appointment Today! Room or who can! Hospital IRRITATION/PAI N Pain Mild to moderate Moderate to severe Accompanied by vision loss Itching Burning eyes Severe Discharge is present Vision is affected Over a period of days or weeks Mild to moderate discomfort Discharge or Watery discharge (tears) Tearing Mucousy discharge. X X X X X X X X X X X. Accompanied by pain and vision loss Red or Bleeding Blood coming out of the eye eye Accompanied by pain and nausea Accompanied by discharge Red spot covering the Iris Red spot on the white of the eye Headache Common Accompanied by scalp tenderness Decreased vision or vision loss Altered behaviour Accompanied by nausea TRAUMA Abrasion Something scratched the eye Foreign body Something in the eye Penetrating injury Blunt trauma Trauma accompanied by a "gush of Ruptured Globe clear fluid" Complaints of pain, watering, and Welders Flash redness after being near a welder IRRIGATE WITH SALINE OR WATER Chemical Splash FOR AT LEAST 15 MINUTES!! OTHER Broken or lost glasses - No Backup Always let them know they will Dilation require a driver. X X X X X X X X X X X X X X X X X X. X X.

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