The SINEH Cardiopulmonary triage scale can be used to triage a patient with chest pain, dyspnea, or other cardiopulmonary complaint. The authors are from Mashhad University of Medical Sciences in Mashhad, Iran.
SINEH means "chest" in Persian.
Triage levels: 1 to 4
Parameters:
(1) SpO2 in percent
(2) PetCO2 in mm Hg
(3) respiratory rate in breaths per minute
(4) systolic blood pressure in mm Hg
(5) serum rapid high sensitivity troponin I
(6) severe unbearable chest pain
(7) peak expiratory flow as percent of predicted
(8) high-risk cardiac profile (unstable angina, history of heart disease, diabetes, age > 50 years, pacemaker, LVEF < 35%, dysrhythmia, critical change in other vital signs)
(9) high-risk pulmonary profile (PEF between 50 and 80%, history of lung disease, history of heart failure, history of liver disease, smoking, age > 70 years, hospitalized > 4 times in past year, serum CRP > 10 mg/dL, leukopenia, use of secondary muscles of respiration, or fever)
Level 1 - any of the following:
(1) SpO2 <= 80
(2) PetCO2 <= 23 mm Hg
(3) respiratory rate >= 32 breaths per minute
(4) systolic blood pressure <= 90 mm Hg
Level 2 option A - either of the following:
(1) SpO2 > 80% AND SpO2 < 92%
(2) PetCO2 > 23 mm Hg AND PetCO2 < 28 mm Hg
Level 2 option B - both of the following:
(1) SpO2 >= 92% AND PetCO2 >= 28 mm Hg
(2) any of the following:
(2a) severe unbearable chest pain
(2b) positive serum troponin I
(2c) peak expiratory flow < 50% of predicted
Level 3 - any of the following:
(1) high-risk cardiac profile AND negative serum troponin I
(2) high-risk pulmonary profile AND peak expiratory flow >= 50% of expected
All other patients are Level 4.
