Irish Children's Triage System: Foreign Body, Non-Inhaled

Parameters

Findings

Category

hemorrhage

exsanguinating

1

severe

2

moderate uncontrolled

3

other

4

none

5

abnormal vital signs

category 1

1

category 2

2

category 3

3

shock

uncompensated

1

compensated

2

none

5

Glasgow coma scale

<= 12

1

13 or 14

2

15

5

substance use

high toxicity

2

moderate toxicity

3

low toxicity

4

none

5

pain

severe (VAS >= 7)

2

moderate (VAS 4-6)

3

mild (1 to 3)

4

none

5

history of bleeding disorder

positive, with active bleeding

2

positive, not actively bleeding

3

negative

5

duration

less than 48 hours (recent) or acute symptoms

4

> 48 hours without acute symptoms

5

history or mechanism

significant

2

inconsistent with findings

3

consistent

5

Other Parameters

Category

airway compromise

1

respiratory failure/arrest

1

penetrating eye trauma

1

temperature > 40°C

2

temperature <= 35.5°C

2

acute hematemesis

2

central capillary refill time > 2 seconds

2

difficulty swallowing

2

history of cyanosis

2

foreign body in nose

3

history of swallowing sharp object

3

local inflammation or infection

4

red eye

4

swelling or deformity

4

purulent discharge at site

4

recent hearing loss

4