Read the fol­low­ing sce­nar­ios and assign a triage cat­e­go­ry for each pre­sen­ta­tion. Help­ful hint – utilise the new ETEK Ver­sion 2 as a ref­er­ence guide.

1. A 24-year-old woman presents to ED with onset this after­noon of bright red PV loss with asso­ci­at­ed left low­er abdom­i­nal pain described as cramp­ing in sen­sa­tion. She has soaked through two pads in the last hour. Pain is 8/10 and she feels nau­se­at­ed. On fur­ther ques­tion­ing, she is late for her men­stru­al peri­od and has been active­ly try­ing with her part­ner for a baby. She is also com­plain­ing of shoul­der tip pain. Obser­va­tions are: HR 102, BP 100/70, Spo2 99% on RA, RR 24, Afebrile 36.8.
2. A three-year-old child presents to your clin­ic – he was play­ing in the gar­den this after­noon and had a fall. He has a pen­e­trat­ing eye injury with a 2cm stick lodged in the inner cor­ner of the cornea and through the upper eye­lid. He is cry­ing and extreme­ly dis­tressed at triage. You are unable to com­plete a full set of obser­va­tions due to dis­tress but note that he is warm, well per­fused and while cry­ing his res­pi­ra­to­ry rate is 36.
3. A 37-year-old man presents with right upper quad­rant pain, onset yes­ter­day evening post eat­ing a home-cooked meal of rice and fish. He is nau­se­at­ed and has vom­it­ed twice in the wait­ing room. He states his pain is 6/10 after hav­ing some parac­eta­mol two hours ago. He tells you this feels like his last ​“gall­stone attack”. His obser­va­tions are: HR 89 reg­u­lar, BP 143/70, Spo2 99% on RA, RR 20, Temp 37.3.
4. A 32-year-old woman presents to your clin­ic with a close friend with a two-week his­to­ry of increas­ing­ly bizarre behav­iours at home – the friend states that the patient is respond­ing to hal­lu­ci­na­tions and has men­tioned hear­ing voic­es that are loud and angry. The patient denies any thoughts of self-harm or harm to oth­ers. The patient is mild­ly agi­tat­ed but calms down when engag­ing with you. Her mood is slight­ly ele­vat­ed but she states she wants help and wants to get back on her reg­u­lar med­ica­tions. On ques­tion­ing, she has pre­vi­ous­ly been on a psy­chi­atric depot medication.
5. You are work­ing at the clin­ic when a ute pulls up and a dis­tressed fam­i­ly mem­ber urgent­ly asks you for help out­side. On arrival out­side after check­ing for dan­ger, you see an uncon­scious female in the back of the ute tray. The fam­i­ly mem­ber states that the patient was rid­ing a horse this after­noon and was bucked off, land­ing on the ground. Ini­tial­ly, she was respon­sive and com­plain­ing of head and neck pain with an obvi­ous frac­ture and defor­mi­ty of her R) arm. On the ride into town the patient became more and more drowsy and is now unre­spon­sive. Dur­ing your pri­ma­ry sur­vey of this patient you note – Air­way: gur­gling sounds (you con­sid­er cspine immo­bil­i­sa­tion to fol­low giv­en the mech­a­nism), Breath­ing – RR 8 shal­low, Cir­cu­la­tion – rapid, thready pulse, Dis­abil­i­ty – Unre­spon­sive on the AVPU scale. You call for help to move her into the clinic.
   

Cor­rect answers

1. Cat 2 – shoul­der tip pain is sug­ges­tive of intraab­dom­i­nal free flu­id with a query ectopic preg­nan­cy. Con­firm urine Beta HCG as soon as pos­si­ble. Severe Pain score of 8 war­rants time­ly management. 
2. Cat 2 – pen­e­trat­ing eye injuries are treat­ed as per the ETEK as a Cat 2. The child is also dis­tressed with pain and this war­rants time­ly management. 
3. Cat 3 – mod­er­ate pain with a his­to­ry of gall­stones requires review with­in 30 mins. Con­sid­er anal­ge­sia and an antiemet­ic while in the WR if possible. 
4. Cat 3 – as per the ETEK guide­lines this patient fits the descrip­tors for a cat­e­go­ry 3 Men­tal Health Triage – this includes: the pres­ence of hallucinations/​delusions, mild agi­ta­tion, and mild­ly ele­vat­ed mood. Think care­ful­ly about where in your clin­ic is safest for this patient to wait and have a low thresh­old for up-triag­ing this patient to a more urgent triage cat­e­go­ry if her behav­iour becomes more ele­vat­ed or there is a risk of harm to her­self or others. 
5. Cat 1 – the patient has an altered lev­el of con­scious­ness with an inabil­i­ty to pro­tect their own air­way, and res­pi­ra­to­ry effort is altered with a low resp rate. You are con­cerned for head injury, and poten­tial cer­vi­cal spine injury and need to com­plete a more detailed sec­ondary sur­vey to assess for any fur­ther seri­ous injury.