V1_APRIL 2023

MSF AWEIL PEDIATRIC TRIAGE

DATE: TIME: ☐AM ☐PM
NAME: AGE: SEX: ☐ M ☐F
OPD CASE: ☐ NO ☐ YES REFERRAL: ☐ NO ☐ YES, FROM:

PRESENTING COMPLAINT: …………………………………………………………………………………………………………………………………….

☐ NOT BREATHING
A/B ☐ CENTRAL CYANOSIS
☐ SEVERE RESPIRATORY DISTRESS
☐ Cold extremities
SIGNS OF SHOCK RED
☐ Weak or fast pulse (or slow)
(ALL 3)
EMERGENCY SIGNS

☐ CRT>3sec IMMEDIATELY
C ☐ Lethargy/unconsciousness TRANSFER TO THE
RESUSCITATION AREA
SEVERE DEHYDRATION ☐ Sunken eyes
(≥ 2 signs) ☐ Unable to drink/drinks poorly
TREAT IMMEDIATELY
☐ Skin pinch goes back very slowly (≥ 2sec)
☐ COMA (AVPU = P or U)
D WEIGH IF POSSIBLE
☐ CONVULSIONS
☐ SEVERE TRAUMA
☐ SEVERE BURNS
☐ CONTAGIOUS DISEASES → ISOLATE

VITAL SIGNS RR: HR: Sat: T°:

WEIGHT: kg MUAC: mm
TRIAGE

Screen MUAC for children 6 to 59 months; SAM if MUAC <115mm, white file if needs admission

☐ TINY BABY (<2 months)

☐ TEMPERATURE <36°C OR >39°C
☐ TRAUMA/SURG EMERGENCY (non-severe) YELLOW
☐ POISONING (snake/scorpion bite; history of) PLACE IN PRIORITY IN
☐ PAIN (severe) THE QUEUE
☐ PALLOR (severe)
PRIORITY SIGNS

☐ RESP DISTRESS (non-severe) INITIAL EVALUATION:

☐ RESTLESSNESS, IRRITABILITY, LETHARGY - VITAL SIGNS
☐ REFERRAL FROM ANOTHER CENTRE - WEIGHT
☐ Severe wasting - NUTRITION STATUS
MALNUTRITION
☐ Edema (both feet)
RE-EVALUATE EVERY
☐ Restlessness, irritability, lethargy 20mins
MODERATE DEHYDRATION ☐ Sunken eyes
(≥ 2 signs) ☐ Drinks eagerly, thirsty MAX. WAIT: 1hr
☐ Skin pinch goes back slowly (<2sec)
☐ BURNS (non-severe)

GREEN → BACK TO MOH

URGENT
NON-

☐ ABSENCE OF EMERGENCY AND PRIORITY SIGNS OR PLACE IN THE QUEUE AFTER ALL THE PRIORITY CASES
REEVALUATE EVERY 60mins
MAX WAIT: 4 hours

NURSE: SIGNATURE:
V1_APRIL 2023

Malaria RDT Treated with ACT in the last 3 weeks BSL Hemoglobin
☐ Positive ☐ Negative ☐ Yes ☐ No mg/dL g/dL
TEST AND TREAT

BSL ≤ 60 mg/dL
Fever >38.5OC Diarrhoea/vomiting
(Neonate<48hrs, <45mg/dL), conscious

☐ ORS (NON-SAM) ☐ ResoMal (SAM)

☐ PARACETAMOL ☐ ORAL G10%
10 mL/kg for each 5 mL/kg for each
15mg/kg PO 10mL/kg PO
loose stool PO loose stool PO
Time: mg Time: mL Time: mL

NURSE: SIGNATURE:

TIME
OBSERVATION

PEWS
BSL
NURSE

ADDITIONAL NOTES: