Prioritizing patients....

[neuronursein06]

Random question- my med surg instructor told us to come to clinical on Tuesday "telling me how you would prioritize 4 patients," without giving us scenarios on a pt in pain, one who's EKG is abnormal, etc. How on earth do I tell her how I would prioritize if she didn't give me scenarios....

[Noryn]

Usually you refer to your ABC's when prioritizing patients. Airway, breathing, then circulation then anything else. You need to think about what will kill the patient. For example if you have someone with chest pain or someone choking--both are emergencies but for the most part the person with chest pain is going to last much much longer than the person choking. That is why airway comes before chest pain(which can be circulation of the heart).

Changes to EKG may very well be considered circulation although it depends on the rhythm. If you are in v-tach, v fib, asystole, or a few others your heart is not circulating the blood. Also bleeding is considered circulation because it affects the blood volume in the body.

You have to also think outside the box though. There are also no definate rules . IF you have a COPD patient they are probably always going to be short of breath to an extent. So if you had a patient that was newly complaining of chest pain then this would probably take priority as long as the shortness of breath on the copd patient is not worsening acutely.

The EKG changes can be tricky also. If someone is in asystole, v-fib or pulseless v tach then that would be a definate priority BUT in these situations the patient is also not breathing so it would be classified as "breathing" instead of circulation.

After the ABCs sudden, severe, or worsening pain is usually the priority.