Appendix D: Telephone Triage

Telephone Triage

This outline provides guidance beyond the initial onset, location, duration, character, quality, and associated symptoms that should be questioned of parents in the context of the high-risk infant.

I. Fever

1. Problem: Temperature >100.4°F

2. Questions:

   1. Does the infant have a shunt? If yes, refer to ED. (See Chapter 22.)

   2. Does the infant have a central line? If yes, refer to ED.

   3. Is the infant under 8 weeks' chronologic age? If yes, refer to ED.

   4. Does the infant have gastrostomy or jejunostomy tube? Is there erythema around site (concern for cellulitis)?

   5. Immunization status or recently received?

   6. Does the infant have ostomy? If so, what is their hydration status? Any change in ostomy output? (See Chapter 29.)

   7. Does the child have history of adrenal insufficiency and requires stress dosing and/or IM Solu-Cortef? (See Chapter 10.)

   8. If answer is “no” to above questions, ask clarifying questions (maximum temperature, associated symptoms, duration). May be seen by PCP next day.

II. Vomiting

1. Problem: Persistent, nonbilious, nonbloody emesis

2. Questions:

   1. Does the infant have a shunt? If yes, refer to ED. (See Chapter 22.)

   2. What medication is the infant taking? Any recent change in formula?

   3. What type of formula is the infant taking?

   4. History of abdominal surgery (concern for obstruction)? (See Chapter 29.)

   5. History of reflux? Do medications need to be weight-adjusted? (See Chapter 14.)

   6. History of urinary tract infection(s)?

   7. What are frequency and consistency of stools?

   8. Urine output (to assess hydration status)?

   9. Does the child have history of adrenal insufficiency and requires stress dosing and/or IM Solucortef? (See Chapter 10.)

III. Diarrhea

1. Problem: Loose, watery stool

2. Questions:

   1. Does the infant have ostomy?

   2. Does the infant have short bowel syndrome? (See Chapter 13.)

   3. Does the infant have history of abdominal surgery? (See Chapter 29.)

   4. Medication history, in particular, recent antibiotic usage?

   5. Does the child have history of adrenal insufficiency and requires stress dosing and/or IM Solucortef? (See Chapter 20.)

IV. Bloody Stool

1. Problem: Blood in stool or from anus

2. Questions:

   1. Recent illness or fever?

   2. Dietary history (on milk-based formula)?

   3. Tears or active bleeding from anus?

   4. Medication history (anticoagulant, antiplatelet treatment)?

V. Difficulty Breathing

1. Problem: Wheezing or noisy breathing, desaturations, retractions, or congestion

2. Questions:

   1. History of chronic lung disease? (See Chapter 7.)

   2. History of pulmonary hypertension? (See Chapter 30.)

   3. History of congenital diaphragmatic hernia? (See Chapter 31.)

   4. History of apnea? Use of apnea monitor? Increased alarms on monitor? (See Chapter 8.)

   5. Oxygen dependence? Recent oxygen wean? O₂ saturations? (See Chapter 7.)

   6. Use of inhaled steroids and/or bronchodilators? (See Chapter 7.)

   7. History of intubation or vocal cord injury (stridor)?

   8. Last feed? Symptoms of aspiration or reflux? History of reflux? On antireflux medication? (See ...