Priority patient...abd pain, vag bleeding, or broken arm

I just had an interview and was asked this question: you are working triage and have the following patients: a pt c/o abd pain, a pt c/o vaginal bleeding, and a child with a broken arm, who do you see first? Using the ABC's I said vaginal bleeding (circulation issue), however abdominal pain could also indicate internal bleeding and a broken arm could cause compromised circulation in that extremity. I was given no other information to use to answer the question...I would love to hear input from all you experienced ER nurses as to what answer you would have chosen and why...:) Thanks so much!!

Keep your fingers crossed for me!! ER nursing is my dream job!

[NeoPediRN]

I would say there's not enough information to determine who takes the priority. Management frequently asks these questions in interviews to see where the question takes you, if you ask for more information, what your thought process is. You would need to know their vital signs, how much bleeding (it could be as simple as the pt's menstrual period, or as complex as pregnant with an abrupted placenta or burst fallopian tube), the history on the pt with abdominal pain (could be an MI or AAA, or are they an ETOHer with a GI bleed), you would have to know what the child's limb looked like...is it an open fracture, is there a radial pulse, what color is the extremity? Any one with a life or limb threatening injury is always an ESI 1, meaning they're the top priority. It's always tough to know how to proceed when you get those triage questions thrown at you!

[NeoPediRN]

PS I strongly disagree with candidates receiving triage questions in an interview unless they've had prior ED experience...triage is something you learn over time, and most hospitals don't allow new ED nurses to triage until a year out.

[DixieRedHead, ASN, RN]

It's a hospital. Not a one room shack. Send the kid to Xray, draw labs & get an EKG on the abdominal pain, labs and pregnancy test for Miss Vag Bleeding.

[CrashED]

You can not decide which patient you can see until you actually get a critical look at them!

[thelema13]

I would've said not enough info to answer question. NeoPediRN had it right, too many variables. If you asked for more info, you were on the right track.

[JDD1017]

Thanks so much for your responses! I also agree that a new nurse without any ER experience shouldn't be asked these questions, but I guess he wants to make sure that he hires nurses who are able to think critically. Hopefully my eagerness outweighs my lack of experience...:)

[VICEDRN, BSN, RN]

Its called visual acuity: do any of them actually look like they are in distress? Its triage. I get to lay eyes on them first because I even talk to them. If I have to choose, I assess the vag bleeder first, then abdominal pain then arm kid. The arm has hours before its really dangerous.

[JDougRN, BSN, RN]

If I couldn't see them, or ask any questions- According to the ESI triage- Vag bleeds are a 2, the abd pain and broken arms would be 3. Of course, if you were actually able to look/asses the pts, it could certainly change.

[hiddencatRN, BSN, RN]

The cynic in me is thinking the vaginal bleeding is a normal period, the abdominal pain is constipation, and the broken arm is going to get a full physical assault workup with social work and everything. Or it's just nursemaids and they're discharged in 10 minute from when the doc reduces the elbow.I wish we could just send patients who obviously need an X-ray to radiology from triage but we do not.

[Mini-Murse]

if the bleeder is pregnant, shes priority #1. if not, the abd pain. could be aaa, could be mi, could be gi bleed, could be gallstones, could be constipation, could be cancer, but it also could be a ruptured spleen, or a bursting appendix.

the kid is #3 for the simple fact that, 99/100 times, a broken arm is not life-threatening.

but dixie has the right idea.

though, you cant just say "

send the kid to xray, draw labs & get an ekg on the abdominal pain, labs and pregnancy test for miss vag bleeding."

because then you're still prioritizing. is contacting radiology more pertinent than getting the ekg and labs, or is the pregnancy test higher priority.

i still think the abd pain is #1 just for the sheer number of etiologies.

[caroladybelle, BSN, RN]

Not nearly enough data for to make an appropriate decision. However, in triage you will first look and question them, and then get vital signs. In many cases, those will lead you to priority.