🔥 Triage – High-Yield Notes for Competitive Exams 🔥

I. Definition of Triage

• Triage is the process of prioritizing patients based on the severity of their condition to ensure that those who need urgent care receive immediate medical attention.
• It is commonly used in emergency departments (EDs), mass casualty incidents (MCIs), disasters, and battlefield medicine.

II. Types of Triage Systems

1. Emergency Department (Hospital-Based) Triage

• Used in: Hospitals, Emergency Rooms (ER).
• Triage Levels:
  • Level 1 – Immediate (Life-threatening) → Cardiac arrest, Major trauma, Stroke.
  • Level 2 – Very Urgent → Severe chest pain, Respiratory distress.
  • Level 3 – Urgent → Moderate trauma, Abdominal pain.
  • Level 4 – Less Urgent → Minor fractures, Fever without complications.
  • Level 5 – Non-Urgent → Minor wounds, Routine follow-ups.

2. Disaster Triage (Mass Casualty Incident – MCI)

• Used in: Natural disasters, Bomb blasts, Earthquakes, War zones.
• System Used: START (Simple Triage and Rapid Treatment) System
• Color Coding System: Color Priority Condition Red (Immediate) Highest Priority Life-threatening, Needs immediate care (e.g., severe bleeding, airway obstruction). Yellow (Delayed) Second Priority Can wait but needs medical care soon (e.g., fractures, moderate burns). Green (Minimal/Walking Wounded) Lowest Priority Minor injuries, can wait (e.g., minor cuts, sprains). Black (Expectant/Deceased) No Priority Dead or unlikely to survive despite treatment (e.g., massive head injury).

3. Military/Battlefield Triage

• Used in: War zones, Combat situations.
• Categories:
  • Immediate: Treatable life-threatening injuries (e.g., massive hemorrhage).
  • Delayed: Requires medical attention but can wait (e.g., fractures).
  • Minimal: Minor injuries (e.g., small cuts).
  • Expectant: Fatally wounded, comfort care only.

4. Reverse Triage

• Used in: Mass casualty situations with limited healthcare resources.
• Concept: Instead of treating the sickest first, priority is given to those with higher chances of survival.
• Used in: Military, Pandemics, Disaster relief.

III. Triage Process

1. Assess Airway, Breathing, Circulation (ABC).
2. Check consciousness (Glasgow Coma Scale).
3. Assess vital signs (BP, HR, RR, Temp).
4. Classify using appropriate triage system (Hospital, Disaster, Military).
5. Tag the patient with appropriate color (Red, Yellow, Green, Black).
6. Direct patient to the correct treatment area.

IV. Triage in Special Situations

Scenario	Triage Consideration
Pregnant Women	Prioritize based on mother & fetal distress
Children (Pediatric Triage)	Uses JumpSTART (Modified START for children)
Elderly Patients	Consider chronic illness, frailty
COVID-19 Pandemic	Respiratory distress = High priority
Burn Victims	Priority based on Rule of Nines (Extent of burns)

V. High-Yield Key Points for Competitive Exams

✅ Most commonly used disaster triage system: START System
✅ Color code for immediate life-saving intervention: Red
✅ Color code for walking wounded patients: Green
✅ Color code for expectant (unlikely to survive) patients: Black
✅ What is Reverse Triage? Prioritizing those with high survival chances first
✅ Which triage system is used for children? JumpSTART Pediatric Triage

📝 Competitive Exam Practice MCQs

1. In disaster triage, which color is given to a patient who needs immediate medical attention?

a) Yellow
b) Green
c) Black
d) Red
✅ Answer: d) Red

2. Which triage system is most commonly used in mass casualty incidents?

a) Glasgow Coma Scale
b) START Triage
c) Reverse Triage
d) Manchester Triage
✅ Answer: b) START Triage

3. What is the primary goal of triage?

a) Treat all patients equally
b) Prioritize patients based on survival chances
c) Treat the most injured first
d) Discharge non-urgent patients immediately
✅ Answer: b) Prioritize patients based on survival chances

🔥 Emergency Conditions – High-Yield Notes for Competitive Exams 🔥

I. Hemorrhage (Severe Bleeding)

• Definition: Excessive blood loss that can lead to shock, hypoxia, and organ failure.
• Types:
  • Arterial Bleeding: Bright red, spurting.
  • Venous Bleeding: Dark red, steady flow.
  • Capillary Bleeding: Oozing, slow.
• Management (First Aid):
  • Apply direct pressure to stop bleeding.
  • Elevate the bleeding site (if possible).
  • Apply tourniquet (if bleeding is severe & life-threatening).
  • Monitor for signs of shock.

II. Shock

• Definition: A life-threatening condition due to inadequate blood flow & oxygen to tissues.
• Types of Shock: Type Cause Signs Hypovolemic Shock Blood loss, Dehydration, Burns Cold skin, Hypotension, Tachycardia Cardiogenic Shock Heart failure, MI Weak pulse, Pulmonary edema Septic Shock Infection (bacterial, viral) Fever, Hypotension, Warm skin Anaphylactic Shock Severe allergic reaction Swelling, Wheezing, Hives Neurogenic Shock Spinal cord injury Bradycardia, Hypotension
• Management:
  • Airway, Breathing, Circulation (ABC) assessment.
  • IV Fluids (Normal Saline, Ringer’s Lactate) for Hypovolemic & Septic Shock.
  • Epinephrine (IM) for Anaphylaxis.
  • Oxygen therapy, Vasopressors (Dopamine, Norepinephrine).

III. Anaphylactic Reaction & Allergies

• Cause: Hypersensitivity reaction to drugs, food, insect stings, latex.
• Symptoms:
  • Early: Hives, Swelling, Itching.
  • Severe: Dyspnea, Wheezing, Hypotension, Shock.
• Management:
  • Epinephrine IM (0.3–0.5 mg) IMMEDIATELY.
  • Antihistamines (Diphenhydramine), Corticosteroids.
  • Maintain airway (intubation if needed).

IV. Trauma (Injuries)

1. Intra-Abdominal Injuries

• Causes: Blunt trauma, Penetrating injuries (stabs, gunshots).
• Signs: Guarding, Abdominal distension, Hypotension.
• Management:
  • Do not give anything orally.
  • IV Fluids, Blood transfusion if needed.
  • Immediate surgery if internal bleeding is suspected.

2. Crush Injuries

• Definition: Prolonged pressure on a body part, causing muscle damage & tissue death.
• Complications: Compartment syndrome, Rhabdomyolysis, Kidney failure.
• Management:
  • IV Fluids (prevent kidney failure).
  • Monitor potassium levels (Hyperkalemia risk).
  • Pain management, Fasciotomy (if needed).

3. Multiple Injuries & Fractures

• Types of Fractures:
  • Closed Fracture: Bone broken but skin intact.
  • Open Fracture: Bone exposed through skin.
• First Aid Management:
  • Immobilize with splints.
  • Do not move a suspected spinal injury.
  • Control bleeding, Provide pain relief.

V. Poisoning

1. Ingested Poisoning

• Examples: Drugs (Overdose), Pesticides, Household Chemicals.
• Symptoms: Nausea, Vomiting, Abdominal pain, Drowsiness.
• Management:
  • Gastric lavage (if within 1 hour).
  • Activated Charcoal (50g) to prevent absorption.
  • Antidotes (e.g., N-acetylcysteine for Paracetamol toxicity).

2. Inhaled Poisoning

• Examples: Carbon monoxide, Chlorine gas, Smoke inhalation.
• Symptoms: Shortness of breath, Cyanosis, Headache.
• Management:
  • Remove from toxic environment.
  • High-flow oxygen therapy.
  • Hyperbaric oxygen therapy (for CO poisoning).

3. Food Poisoning

• Common Causes: Bacteria (Salmonella, E. coli), Contaminated food.
• Symptoms: Vomiting, Diarrhea, Dehydration.
• Management:
  • Oral Rehydration Solution (ORS) for dehydration.
  • IV Fluids if severe dehydration.
  • Antibiotics if bacterial infection suspected.

4. Injected Poisons – Stings, Bites

a) Insect Stings (Bees, Wasps, Spiders)

• Symptoms: Swelling, Pain, Allergic reaction (in severe cases).
• Management:
  • Remove stinger (if present).
  • Apply cold compress.
  • Epinephrine for severe reactions.

b) Snake Bites

• Venomous Snakes: Cobras, Vipers, Kraits.
• Symptoms: Pain, Swelling, Neurotoxic effects (paralysis).
• Management:
  • Immobilize limb, Keep below heart level.
  • Do not cut, suck venom, or apply tourniquet.
  • Administer Anti-Snake Venom (ASV).

c) Chemical Burns

• Common Causes: Acid burns (sulfuric acid), Alkali burns (bleach).
• Management:
  • Flush with large amounts of water for at least 15-30 minutes.
  • Do not neutralize with acid/alkali.

VI. Environmental Emergencies

1. Heat Stroke

• Cause: Prolonged heat exposure, Dehydration.
• Symptoms: Core temp > 40°C, Hot & dry skin, Confusion, Seizures.
• Management:
  • Cool patient rapidly (ice packs, cold IV fluids).
  • Monitor vitals, IV Fluids, Electrolyte correction.

2. Frostbite

• Cause: Freezing of skin & underlying tissues.
• Symptoms: Numbness, Hard skin, Blisters.
• Management:
  • Gradual warming (warm water immersion).
  • Do not rub affected area.

3. Near Drowning

• Cause: Submersion in water leading to hypoxia & organ damage.
• Symptoms: Cyanosis, Gasping, Unconsciousness.
• Management:
  • Rescue breathing (if no breathing).
  • Intubation & Oxygen therapy (if severe).
  • Monitor for secondary drowning (Pulmonary edema).

🔥 High-Yield Key Points for Competitive Exams

✅ Best management for anaphylaxis: IM Epinephrine
✅ Best initial management for snake bites: Immobilize limb, Keep below heart level
✅ Common cause of hypovolemic shock: Severe blood loss (Hemorrhage)
✅ Best treatment for cyanide poisoning: Sodium Thiosulfate & Hydroxocobalamin
✅ Common antidote for opioid overdose: Naloxone
✅ Best way to treat chemical burns: Flush with water (15-30 min)

---

📝 Competitive Exam Practice MCQs

1. Which drug is the first-line treatment for anaphylaxis?

a) Diphenhydramine
b) Epinephrine
c) Hydrocortisone
d) Salbutamol
✅ Answer: b) Epinephrine

2. What is the most important management step in near-drowning cases?

a) Provide warm blankets
b) Give fluids
c) Ensure airway & breathing
d) Give antibiotics
✅ Answer: c) Ensure airway & breathing