Critically Ill Patient in Paediatric Emergency Department
The critically ill patient is the patient who presents unstable vital functions and which, in the absence of a fast medical intervention, may develop severe complications. In this regard, the attitude of the nurse is important; any tardiness in recognising and therapeutically intervening may lead to the damage of the patient's condition.
The Romanian National Triage Protocol uses Emergency Severity Index (ESI), 5 levels of triage, depending on how severe the patient's state is at attendance. Critical patients are considered to be those patients which fit in the levels of triage 1 and 2.
The effected study is an observational one, retrospective, made on patients who fit in levels of triage 1 and 2, present in Paediatric Emergency Department of Cluj-Napoca (UPU) in the year 2017. A total number of 28222 patients were enrolled in the study, out of which 1680 fit in the level of triage 1 and 2, representing 6% of the total sample.
The analysing criteria was basic pathology: respiratory (23 %), trauma (19,34 %), seizzures (11,9 %), intoxications (7,9 %), severe dehydration (4,2%), cardiac (3,8 %), respiratory/ cardiorespiratory arrest (0,6 %), other pathologies (29 %) and were evaluated the immediately taken measures: the initial measure of vital parameters (98%), continuous monitoring (42,38%), oxygen therapy (12,38 %), nebulization (16,25%), venous access (77,55 %), etc.
The average stationary period in UPU was of 152 minutes (approximatively 2 hours and 30 minutes).
The nurse must recognise the critically ill patient, must intervene by applying the immediate measures for ameliorating the patient's state, must observe the evolution of the patient and, in need, ask for the doctor's assistance..
It was highlighted a deficiency in monitoring the patients initially considered critically ill. Potential causes discussed are: the short stationary period in UPU (? 60 minutes in the case of 27,83% of the patients initially considered critically ill), the temporary absence of the patient form UPU while imagistic investigations or speciality consulting were being made (40,95%), or errors in patient management (31%).
