Emergency Department Triage Manual, V

ED Triage Manual, V

Vaginal Bleeding
Vaginal Discharge
Vomiting
VP Shunt

Vaginal Bleeding

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
Acute mental status change < 8 wks post-partum with vaginal hemorrhage	Tachycardia Peritoneal irritation Dizziness, syncope, or near syncope Pallor	Straddle injury Hx: foreign body	Dysmenorrhea STI exposure	Newborn ≤ 3 wks Menses

Vaginal Discharge

If patient presents with any abdominal pain, use abdominal pain criteria.

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
	Concern for child abuse Concern for Abuse- see Sexual Assault	STI exposure with discharge	Discharge without abdominal pain Itching Hx: foreign body Return for + culture results

Vomiting

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
Active hematemesis	Kussmaul respirations Irritable, not consolable Severe headache Diplopia Incarcerated hernia Bloody diarrhea with crampy abdominal pain Age < 10 wks with projectile emesis Vomiting stool Peritoneal signs Hx: IDDM metabolic disease Resolved hematemesis with Hx: liver disease/transplant, hematologic disorder, IBD Green bilious emesis Recent blunt abdominal trauma	Listless Flank pain Hx: foreign body	Resolved hematemesis Amenorrhea Constipation
See Dehydration

VP Shunt

1 Critical	2 Acute	3 Urgent	4 Urgent	5 Non-Urgent
Bradypnea/apnea Bradycardia Sunset eyes Acute mental status change Extreme agitation Combative Unresponsive Active seizure	Irritable Listless Headache Vomiting Full fontanelle Fever, fever ≥ 38°C (100.4°F) with shunt revisions < 3 mos Ataxia	Erythema and/or exudate at insertion site Swelling over reservoir site Fever, hx: fever ≥ 38°C (100.4°F) with last shunt revision ≥ 3 mos ago

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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