Triage Assessment

Emergency department triage — 5-level Manchester Triage System

Patient

Arrival

Triage Nurse

Chief complaint

Brief history / AMPLE

BP (mmHg)

HR (bpm)

RR (/min)

SpO2 (%)

Temp (°C)

Blood Glucose (mg/dL)

Eye Opening (E) (max 4)

4=Spontaneous,3=To voice,2=To pain,1=None

Verbal Response (V) (max 5)

5=Oriented,4=Confused,3=Words,2=Sounds,1=None

Motor Response (M) (max 6)

6=Obeys,5=Localises,4=Withdraws,3=Flexion,2=Extension,1=None

Immediate Actions

Assigned Bay / TrolleyDoctor Assigned