⚙ ED Workflow Overview — Triage to Discharge

  1. Arrival & Registration — Patient registers at reception; basic demographics captured. Walk-in vs ambulance vs aeromedical.
  2. Triage — Nurse assigns MTS category (1–5); vital signs documented; initial assessment ≤10 min for Cat 1–2.
  3. Streaming — Patient directed to appropriate stream: Resus / Majors / Minors (Fast Track) / Paediatrics.
  4. Assessment & Investigations — History, examination, nursing assessment; bloods / ECG / imaging ordered.
  5. Definitive Treatment — Medical officer review; treatment initiated; specialist referrals placed.
  6. Disposition Decision — Discharge / Admit / Transfer / Observation unit / Left without being seen (LWBS).
  7. Discharge / Handover — Discharge instructions in patient's language; ward handover ISBAR format.

▶ Manchester Triage System (MTS)

LevelColourNameMax Wait
1RedImmediate0 min
2OrangeVery Urgent10 min
3YellowUrgent60 min
4GreenStandard120 min
5BlueNon-Urgent240 min

MTS is widely adopted across GCC EDs. Some facilities use a 3-level or 4-level system — confirm local policy.

◔ Patient Streaming

Resuscitation Bay

MTS 1–2, cardiac arrest, major trauma, severe respiratory distress, altered consciousness.

Majors

MTS 2–3, moderate-severity illness, requires investigations, monitoring >2 hours likely.

Fast Track / Minors

MTS 3–5, ambulatory patients, minor injuries, simple presentations. Target: see and treat <4h.

GP / Primary Care Redirection

MTS 4–5 with no acute pathology — consider redirect to polyclinic (Aster, NMC, DHA clinics). Document refusal if patient declines redirect.

📊 Overcrowding — NEDOCS Score

ScoreStatusAction
0–20Not CrowdedRoutine operations
21–60BusyMonitor, maintain flow
61–100OvercrowdedBed manager alert, expedite discharges
101–140Severely OCEscalate to hospital command, consider divert
>140Dangerously OCCode census / Major Incident protocol

📋 ED Whiteboard & Bed Management

ED Whiteboard / Tracking System

  • Real-time patient location tracking (cubicle / bay / awaiting bed)
  • Assigned nurse, MO, and consultant visible
  • Colour flags: bloods pending / imaging / specialist review / discharge ready
  • 4-hour clock visible for each patient

Patient Boarding

Admitted patients held in ED awaiting inpatient bed. Target: <4h boarding time. Boarding nurse assigned; handover documents completed even while boarding.

Escalation Policy

  • Charge nurse escalates to bed manager at NEDOCS >100
  • Bed manager activates ward discharges / elective cancellations
  • CNO / Medical Director notified at NEDOCS >140

🛠 Resus Bay Setup — Daily Equipment Checks

Airway Trolley

  • BVM (bag-valve-mask) ×2 sizes
  • OPA sizes 0–5, NPA 6–9 Fr
  • Video laryngoscope + blades (Mac 3, 4)
  • ETT sizes 6.5, 7.0, 7.5, 8.0 + 10ml syringe
  • Stylet / bougie
  • Difficult airway trolley (nearby)
  • Surgical airway kit (cricothyrotomy)

Crash Cart

  • Adrenaline 1:10,000 for cardiac arrest
  • Amiodarone 300mg
  • Atropine 1mg/10ml
  • Sodium bicarbonate 8.4%
  • IV access: 14G–22G cannulas
  • IO kit (EZ-IO drill)
  • Defibrillator / AED (checked daily)

Monitoring & Other

  • Cardiac monitor (12-lead capability)
  • Pulse oximetry, ETCO₂ waveform
  • Portable ultrasound (POCUS)
  • Rapid infuser (Level 1 / Belmont)
  • Point-of-care bloods: iSTAT / ABG analyser
  • Warmed IV fluids storage
  • Warming blanket / Bair Hugger

📋 ABCDE Primary Survey — Systematic Assessment

A

Airway

Patent? Speaking in full sentences? Stridor / gurgling / snoring? Jaw thrust if C-spine risk. Suction if secretions. Consider OPA/NPA. Intubation if GCS ≤8 or unprotected airway.

B

Breathing

RR, SpO₂, chest rise symmetry, auscultation, trachea midline, accessory muscle use. O₂ target SpO₂ 94–98% (88–92% in COPD). 15L/min NRB mask if compromised.

C

Circulation

HR, BP, cap refill, skin colour/temperature, JVP. IV access ×2 large-bore. Bloods: FBC, UEC, LFTs, coags, troponin, VBG, group & hold. 250ml–500ml NS bolus if hypotensive.

D

Disability

GCS (E/V/M), pupils (size, reactivity, equality), BGL (capillary glucose — treat hypoglycaemia <4 mmol/L immediately), posture, focal neuro deficit.

E

Exposure

Full exposure — log roll, inspect back, perineum, axillae. Maintain dignity. Temperature (rectal if accurate needed). Document all injuries / skin findings.

👥 Resus Team Roles — Simultaneous Actions

Airway Nurse

  • Positions patient (sniffing position)
  • Pre-oxygenation: NRB / BVM 3–5 min before RSI
  • Assists with laryngoscopy; applies cricoid pressure (BURP technique)
  • Confirms ETT placement: ETCO₂ + auscultation + CXR
  • Secures tube; documents ETT depth at lips (♀ ~21cm, ♂ ~23cm)

Monitor Nurse

  • Attaches cardiac monitor + SpO₂ + ETCO₂
  • 12-lead ECG within 10 min of arrival for chest pain / arrest
  • Documents vitals every 5 min during resus
  • Calls out deteriorating parameters to team leader

IV / Drug Nurse

  • Establishes 2× large-bore IV access (AC / EJ / IO if failed)
  • Draws up RSI medications prior to intubation attempt
  • Labels all syringes: drug name + concentration
  • Administers medications as directed; reads back verbal orders
  • IO: confirm placement, flush 10ml NS before each drug

Scribe Nurse

  • Documents all interventions with exact timestamps
  • Records all drugs: dose, route, time, administered by
  • Tracks CPR cycle times (2-min cycles)
  • Maintains situational awareness; prompts team on time

💉 Rapid Sequence Intubation (RSI) — Nurse Role

Verbal read-back of all RSI drug orders. Label syringes immediately after drawing.

Drug Draw-Up (Standard Adult)

DrugRoleTypical Dose
FentanylPre-medication (attenuate pressor response)1–3 mcg/kg IV
KetamineInduction (haemodynamically stable)1–2 mg/kg IV
PropofolInduction (avoid if hypotensive)1–2 mg/kg IV
SuxamethoniumParalytic (depolarising, 60s onset)1.5 mg/kg IV
RocuroniumParalytic (non-depol, use if sux CI)1.2 mg/kg IV

Cricoid Pressure

Sellick manoeuvre: posterior pressure on cricoid ring to occlude oesophagus. Controversial — may worsen laryngoscopy view.

BURP: Backwards-Upwards-Right Pressure on thyroid cartilage to optimise laryngoscopy view — preferred technique by laryngoscopist.

Failed Airway Trolley

  • LMA / i-gel (supraglottic airway device)
  • Fiberoptic bronchoscope
  • Surgical airway kit (Melker, scalpel-bougie-tube)
  • Retrograde intubation set
  • Call for senior/anaesthetics immediately

💊 Vasopressors in Emergency

DrugIndicationDoseNotes
NoradrenalineSeptic / distributive shock (1st line)0.01–1 mcg/kg/min IV infusionCentral line preferred; can start peripheral short-term
Adrenaline (Anaphylaxis)Anaphylaxis0.5mg (500mcg) 1:1,000 IM anterolateral thighRepeat q5–15 min if no response. Never IV bolus for anaphylaxis unless cardiac arrest
Adrenaline (Arrest)Cardiac arrest (PEA/Asystole/VF)1mg (1:10,000) IV q3–5 minAfter 2nd shock in shockable rhythm; every cycle in non-shockable
DopamineCardiogenic shock, bradycardia2–20 mcg/kg/min IV infusionLow dose dopaminergic; mid dose inotropic; high dose vasopressor. Largely replaced by NA/adrenaline

💊 Sedation Agents

DrugKey FeaturesDose (Procedural)Cautions
KetamineDissociative; preserves airway reflexes & BP; bronchodilator1–1.5 mg/kg IV or 4 mg/kg IMEmergence reactions (co-give midazolam); raises ICP — use caution in head injury; laryngospasm rare
PropofolRapid onset/offset; anti-emetic; excellent sedation quality0.5–1 mg/kg IV (titrate)Apnoea & hypotension risk — airway equipment mandatory; pain on injection; propofol infusion syndrome (ICU doses)
MidazolamAnxiolytic, amnestic, anticonvulsant0.02–0.05 mg/kg IV slowlyRespiratory depression; accumulates in elderly/renal failure; reversal: flumazenil (rarely used)

💊 Anticonvulsants

DrugIndicationDoseNotes
LorazepamStatus epilepticus — 1st line0.1 mg/kg IV (max 4mg) — repeat ×1Preferred benzodiazepine for status; slow onset if IM
Diazepam IVStatus epilepticus — alternative0.15 mg/kg IV (max 10mg)Rectal diazepam 0.5 mg/kg if no IV access
Levetiracetam2nd line / maintenance after benzodiazepines60 mg/kg IV over 10 min (max 4.5g)Fewer drug interactions than phenytoin; safe in liver disease; IV levetiracetam (Keppra) increasingly used in GCC EDs
Sodium ValproateStatus epilepticus — 2nd line40 mg/kg IV over 10 min (max 3g)Avoid in liver disease, pregnancy (teratogenic)

☣ Antidotes

AntidoteToxinDoseKey Points
NaloxoneOpioid overdose0.4mg IV/IM/IN; repeat q2–3 min; infusion if neededTitrate to adequate respiration — NOT to full consciousness. Short half-life (30–90 min) — may need repeat doses or infusion. Monitor for re-sedation.
FlumazenilBenzodiazepine reversal0.2mg IV q1 min; max 1mgRarely used — may precipitate seizures in benzo-dependent patients or mixed overdoses. NOT routine. Call toxicology.
N-Acetylcysteine (NAC)Paracetamol overdoseIV: 150mg/kg in 200ml D5W over 1h, then 50mg/kg over 4h, then 100mg/kg over 16hRumack-Matthew nomogram — plot serum paracetamol vs time since ingestion (≥4h). Treat if above treatment line. See interactive tool below.
AtropineOrganophosphate / bradycardia1–3mg IV; repeat until secretions dry (OPC)Large doses required in organophosphate poisoning (up to 20mg+). Endpoint: dry secretions, not tachycardia.
📞 Always contact Poisons Information Centre for complex overdoses. GCC regional: Dubai Poison Control +971 4 219 2100 | Saudi: 966-920-002-226

💊 Thrombolytics

AgentIndicationTime TargetDose
Alteplase (tPA)STEMI (if PCI not available within 120 min)Door-to-needle <30 min15mg IV bolus → 0.75 mg/kg over 30 min → 0.5 mg/kg over 60 min (max 100mg)
Alteplase (tPA)Ischaemic strokeDoor-to-needle <60 min; onset <4.5h0.9 mg/kg (max 90mg); 10% as bolus, 90% over 60 min
Tenecteplase (TNK)STEMI (preferred, single bolus)Door-to-needle <30 minWeight-based IV bolus (30–50mg by weight band)
Absolute CI to thrombolytics: prior haemorrhagic stroke, active bleeding, recent surgery (<3 months), BP >185/110 mmHg (stroke), aortic dissection.

⚙ Paracetamol Overdose Assessment — Rumack-Matthew Nomogram

Estimate treatment line threshold: serum paracetamol vs hours post-ingestion. Use for single acute ingestion.

❤ Chest Pain — Risk Stratification

Key Differentials

  • ACS — crushing, radiation, diaphoresis, ECG changes, troponin rise
  • Aortic Dissection — tearing, maximum at onset, BP differential >20mmHg, wide mediastinum
  • PE — pleuritic, dyspnoea, tachycardia, low SpO₂, DVT risk
  • Tension Pneumothorax — absent breath sounds, tracheal deviation, hypotension
  • Pericarditis — positional, sharp, pericardial rub, saddle ST
  • Musculoskeletal — reproducible on palpation, positional

Risk Tools

HEART Score: History / ECG / Age / Risk Factors / Troponin — see interactive calculator below.

Wells PE Score: DVT signs, HR>100, immobilisation, prior PE/DVT, haemoptysis, active cancer, PE most likely dx. Score <2 = low; 2–6 = moderate; >6 = high.

Stanford Aortic Dissection: high-risk features (pain character, pulse deficit, BP differential, wide mediastinum) — CTA chest-abdomen-pelvis urgently.

Key Nursing Actions

  • 12-lead ECG within 10 min of arrival
  • IV access, troponin (hs-cTnI/T), D-dimer, BGL, CXR
  • Aspirin 300mg PO if ACS suspected (confirm no allergy)
  • GTN 400mcg SL if SBP >90mmHg — sit patient up

⚙ HEART Score Calculator — ACS Risk Stratification

💨 Dyspnoea — Key Differentials

COPD Exacerbation

  • Known COPD history, wheeze, prolonged expiratory phase
  • Nebulised salbutamol + ipratropium; oral/IV prednisolone
  • Controlled O₂: SpO₂ target 88–92%
  • CXR to exclude pneumonia; ABG if RR >30 or SpO₂ <88%
  • NIV (BiPAP) if pH <7.35 and hypercapnic

Pulmonary Oedema (APO)

  • Orthopnoea, PND, pink frothy sputum, bibasal crepitations
  • GTN infusion, IV frusemide 40–80mg, sit upright
  • CPAP if severe; intubation if failing
  • Echo (POCUS): B-lines ≥3 in ≥2 zones bilaterally

Pulmonary Embolism

  • PERC Rule (low-risk if all 8 negative): age <50, HR <100, SpO₂ ≥95%, no leg swelling, no haemoptysis, no recent surgery/trauma, no prior DVT/PE, no oestrogen use
  • Wells score → D-dimer (if low prob) or CTPA directly (if high prob)
  • Massive PE: consider thrombolysis or surgical embolectomy

ABCDE Approach to Dyspnoea

  • Position: upright reduces work of breathing
  • High-flow O₂ first (unless known COPD)
  • POCUS: cardiac function, pleural effusion, pneumothorax
  • Do not delay treatment waiting for complete history in severe distress

🧠 Altered Consciousness — AEIOU-TIPS

A
Alcohol — intoxication, withdrawal (Wernicke's — give thiamine 100mg IV first)
E
Epilepsy — post-ictal state; check for injuries, BGL, temperature
I
Insulin (Metabolic) — hypoglycaemia (treat with 50ml 50% dextrose IV), hyperglycaemia (DKA/HHS)
O
Overdose/Opioids — miotic pupils, bradypnoea → naloxone; broad toxidrome assessment
U
Uraemia — renal failure (asterixis, pericardial rub, uraemic fetor)
T
Trauma — head injury, intracranial bleed; full C-spine precautions until cleared
I
Infection — meningitis (fever, neck stiffness, rash), encephalitis, sepsis; LP after CT if ICP not suspected
P
Psychiatric/Psychogenic — diagnosis of exclusion; do not miss organic causes
S
Stroke/Structural — acute stroke (face/arm weakness, speech), space-occupying lesion, hypertensive encephalopathy

💨 Sepsis — Early Recognition & Bundle

qSOFA Score (bedside)

1 point each: RR ≥22/min | Altered mentation (GCS <15) | SBP ≤100 mmHg

Score ≥2 = high suspicion for sepsis → full assessment

Sepsis Definition (Sepsis-3)

Life-threatening organ dysfunction caused by dysregulated host response to infection. SOFA score increase ≥2 from baseline.

Septic Shock: Vasopressor needed to maintain MAP ≥65 mmHg AND lactate >2 mmol/L despite adequate fluid resuscitation.

Hour-1 Bundle (Surviving Sepsis Campaign)

  1. Measure lactate; re-measure if >2 mmol/L
  2. Blood cultures ×2 sets BEFORE antibiotics
  3. Broad-spectrum antibiotics — target <1h for septic shock
  4. 30 ml/kg crystalloid IV for hypotension or lactate ≥4 mmol/L
  5. Noradrenaline if hypotension during/after fluid — MAP target ≥65
Every hour delay in antibiotics in septic shock ≈ 7% increase in mortality.

💉 Venous Access

Peripheral IV (PIV)

  • 14G (orange) or 16G (grey) — major trauma/resus
  • 18G (green) — standard adult ED admission
  • ACF preferred; dorsal hand/EJ as alternatives
  • Document: gauge, site, date/time, flush, patent

Intraosseous (IO) — EZ-IO

  • Sites: proximal tibia (2cm below tibial tuberosity) | proximal humerus | distal tibia | sternal (FAST-1 device)
  • Confirm placement: blood/marrow aspirate, easy flush, no swelling
  • After each drug: flush 10ml normal saline to push drug centrally
  • IO flow rates can be enhanced with pressure bag
  • Remove within 24h; document time of insertion

💉 Arterial Blood Sampling (ABG)

  • Radial artery preferred — perform Allen's test first
  • Femoral artery for failed radial / haemodynamic compromise
  • Use pre-heparinised syringe; remove all air bubbles
  • Apply firm pressure 5 min (10 min if anticoagulated)
  • Process within 15 min or pack in ice

Interpreting ABG — Rapid Screen

ParameterNormal
pH7.35–7.45
PaCO₂35–45 mmHg
PaO₂80–100 mmHg
HCO₃22–26 mEq/L
Lactate<2 mmol/L

💉 Wound Management

Wound Irrigation

  • Irrigate with normal saline under pressure (35ml syringe + 18G cannula = ~7 psi)
  • Minimum 100–200ml per wound; more for contaminated wounds
  • Debride necrotic/foreign material
  • Photograph wound before and after closure

Closure Options

  • Sutures: Cosmetic areas (face 5-0/6-0), body (3-0/4-0 nylon). Remove: face 5d, scalp 7d, trunk 10d, limbs 10–14d.
  • Staples: Scalp, trunk — fast, strong. Remove 7–10d.
  • Tissue adhesive (Dermabond): Low-tension, linear wounds <5cm. Do not use over joints.
  • Steri-Strips: Low-tension, minor lacerations. Reinforce after suture removal.

Tetanus Prophylaxis

ImmunisationClean woundDirty wound
Up to date (≤5y)NothingNothing
5–10 years agoNothingTetanus toxoid
>10 years / unknownTetanus toxoidToxoid + TIG

TIG = Tetanus Immunoglobulin 250 IU IM. Give at different site to toxoid.

Wound Infection Signs (Review)

  • Warmth, erythema, swelling, purulent discharge, fever
  • Bites (human/animal) — high infection risk, consider prophylactic augmentin

💉 Splinting

SAM Splint

  • Aluminium foam splint — malleable, lightweight
  • Upper limb fractures, ankle sprains, temporary immobilisation
  • Pad bony prominences; check neurovascular status distal to splint
  • Reassess at 30–60 min for compartment syndrome signs

Plaster of Paris (POP)

  • Exothermic — warn patient of warmth during setting
  • Drying time: 24–72h (do not weight bear for 48h minimum)
  • Stockinette + wool undercast + POP (6–8 layers)
  • Bivalve if swelling anticipated (open cast)
  • Compartment syndrome signs: Pain out of proportion, pain on passive stretch, pallor, paraesthesia, pulselessness — remove cast immediately

💨 Basic Airway Manoeuvres

Jaw Thrust

Preferred in suspected C-spine injury. Fingers at angle of mandible, push jaw forward. Maintains neutral C-spine alignment.

Oropharyngeal Airway (OPA)

Sizing: corner of mouth to earlobe. Insert inverted (concave upward) then rotate 180° in adults. Do NOT use if gag reflex present.

Nasopharyngeal Airway (NPA)

Sizing: 6–9 Fr (♂ 7–9, ♀ 6–7). Lubricate well. Insert along nasal floor, bevelled edge toward septum. Safe with intact gag reflex. Avoid if base-of-skull fracture suspected.

💉 Urinary Catheterisation in Emergency

🚘 Road Traffic Accidents (RTAs)

RTA remains the leading cause of trauma ED presentations across the GCC. Contributing factors include high-speed limit roads (120–140 km/h), historical low seatbelt compliance (though improving with enforcement), mobile phone use while driving, and large numbers of heavy vehicles.

RTA Nursing Priorities

  • Full C-spine immobilisation until cleared clinically + radiologically
  • ATLS primary survey: ABCDE simultaneously with team
  • FAST ultrasound (Focused Assessment Sonography in Trauma)
  • Massive transfusion protocol (MTP) activation threshold: SBP <90 + mechanism
  • Permissive hypotension in penetrating trauma (SBP 80–90 target until haemostasis)
  • Pelvic binder if pelvic fracture suspected

Leading Trauma EDs in GCC

  • Rashid Hospital, Dubai — Level 1 Trauma Centre; primary trauma referral for Dubai
  • King Khalid University Hospital, Riyadh — tertiary trauma and emergency care, Saudi Arabia
  • King Fahad Medical City, Riyadh — major trauma centre, KSA
  • Hamad General Hospital, Doha — Qatar's primary emergency and trauma centre
  • Sheikh Khalifa Medical City, Abu Dhabi

☀ Heat-Related Illness — Seasonal Peak

UAE summer temperatures routinely exceed 45°C with high humidity. Heat stroke is a medical emergency with mortality up to 50% if untreated.

Heat Exhaustion

  • Temp <40°C, intact mental status
  • Weakness, dizziness, diaphoresis, nausea
  • Cool environment, oral or IV fluids (0.9% NaCl)
  • Rest, remove from heat, monitor

Heat Stroke (Emergency)

  • Temp >40°C + CNS dysfunction (confusion, seizure, coma)
  • Exertional (outdoor workers, athletes) vs Classic (elderly, comorbid)
  • Target: lower core temp to <38.9°C within 30 min

Cooling Methods

  • Cold water immersion — most effective; 2–4°C water or ice slurry bath
  • Ice packs: neck, axillae, groin (vascular areas)
  • Evaporative cooling: mist + fan (widely used in GCC EDs)
  • IV cooled NS (4°C) for severe/core cooling
  • Intubate if GCS ≤8 — aspiration risk during cooling
Monitor: Rhabdomyolysis (CK, myoglobin), DIC, AKI, hepatic failure. Aggressive organ monitoring post-cooling for 24–48h.

🏦 Mass Gathering Events

GCC hosts major mass gathering events requiring surge planning and dedicated medical resources.

Key Events

  • Dubai World Expo / EXPO 2020 — global attendance, multilingual population
  • Abu Dhabi F1 Grand Prix — Yas Marina Circuit; trauma + heat + substance-related presentations
  • Hajj Pilgrimage, Mecca — world's largest annual mass gathering; crush injuries, heat stroke, respiratory illness (MERS risk historically)
  • Dubai Shopping Festival / New Year Events

Mass Casualty Incident (MCI) Protocol

  • START Triage: Immediate (Red) / Delayed (Yellow) / Minor (Green) / Expectant (Black)
  • Activate Hospital Incident Command System (HICS)
  • Notify MoH / DHA / HAAD as per jurisdiction
  • Expand ED capacity: discharge non-urgent patients, open overflow areas
  • Assign media liaison officer; restrict non-essential communication

🐛 Envenomation — Desert & Coastal

Snake Envenomation

  • UAE/KSA desert vipers (Cerastes, Echis), cobras (Naja)
  • Immobilise limb; keep below heart level; remove jewellery
  • NO incision, suction, tourniquet, or ice
  • Mark swelling progression with pen + time
  • Antivenom: contact regional toxicology/poison centre for supply
  • Monitor: coagulopathy (PT/APTT/fibrinogen), local tissue necrosis

Scorpion Sting

  • Androctonus, Leiurus species in GCC — potentially fatal
  • Local pain, systemic: tachycardia, diaphoresis, pulmonary oedema, seizures
  • Supportive: pain management, IV fluids, benzodiazepines for agitation
  • Scorpion antivenom (available in Saudi Arabia)

Jellyfish Sting (Gulf Coast)

  • Box jellyfish rare in Gulf; more commonly Portuguese Man-o-War, Chrysaora
  • Remove tentacles with card/stick — NOT bare hands
  • Irrigate with seawater (NOT fresh water — worsens nematocyst firing)
  • Hot water immersion (45°C) for pain relief
  • Antihistamine for urticaria; adrenaline if anaphylaxis

Camel Bite

  • Crush injuries; polymicrobial contamination (Pasteurella, Streptococcus)
  • Thorough wound irrigation; surgical debridement often needed
  • Antibiotics: co-amoxiclav (augmentin) ± metronidazole
  • Tetanus prophylaxis; consider rabies risk if animal health unknown

🌐 Language Barriers in the Multilingual ED

The GCC ED serves a highly diverse population — over 180 nationalities in Dubai alone. Language barriers are a significant patient safety risk.

Communication Strategies

  • Telephone interpretation services (available 24/7 in major GCC hospitals)
  • Trained in-hospital interpreters — preferred for consent, complex history
  • Visual pain scale (numeric + faces scale)
  • Translated discharge instruction cards (Arabic, English, Urdu, Hindi, Tagalog, Bangla common in GCC)
  • Google Translate / medical translation apps — supplementary only, not for consent
  • Family members as interpreters — use cautiously (do not use for sensitive topics)

GCC Triage Colour Coding Systems

Most GCC countries follow international 5-level colour triage aligned with MTS or CTAS:

ColourLevelUsed In
RedImmediate (1)UAE, KSA, Qatar, Bahrain
OrangeVery Urgent (2)UAE (MTS), KSA (CTAS-aligned)
YellowUrgent (3)All GCC
GreenStandard (4)All GCC
BlueNon-Urgent (5)UAE, Qatar

🧠 Practice MCQs — Emergency Nursing

10 questions. Instant feedback. Score shown after all answered.

1. In the Manchester Triage System, a patient with severe chest pain, diaphoresis and SBP 80 mmHg should be triaged as:
2. When administering drugs via an intraosseous (IO) route, what must follow each drug administration?
3. Which of the following is CORRECT regarding naloxone use in opioid overdose?
4. A patient in the GCC ED presents with core temperature 41.2°C and confusion after working outdoors. The MOST effective cooling method is:
5. A HEART score of 7 indicates which risk level and recommended management?
6. In RSI, the BURP technique refers to:
7. For the Hour-1 Sepsis Bundle, what is the target time for antibiotic administration in septic shock?
8. A snake bite patient arrives at the ED. Which of the following actions is CORRECT?
9. The PERC rule is used to rule out which condition in low-risk patients?
10. An OPA (oropharyngeal airway) is sized correctly when it extends from: