Question (disaster/emerg.)

letina · Jul 26, 2005

Sending to be treated means being sent to the hospital, whether it is by helicopter or ambulance, that doesn't make any difference. The walking wounded are going to be the last to be sent, if they are even sent.

Ah, now I see :innerconf

Then I revert to my original answer, #2

ckh23, BSN, RN · Jul 27, 2005

The appropriate triage order is 2, 3, 4, 1.
#2 is first due to the airway compromise, not because of who can best help you or help you first.
Is this the exact way the question was worded on the test? Typically these types of questions refer to 'who to treat first' rather than 'who to send to get medical help'.

But this is a disaster/emergency question. This is not your typical "you come on shift and which of these patients do you see first". In disasters you help the most stable patient first so that they can assist you.

suzanne4, RN · Jul 27, 2005

None of those patients are going to be able to assist you.

The question is who are you going to send for medical help the first? If they are that stable, they are not going to get sent first, they may get sent last or not at all. The key word is sent, if they are sent, they aren't going to be there to be able to help you at all.

That is what you need to add into the equation, the word "sent." Otherwise you are completely right...............

Home Health Columnist / Guide · Jul 27, 2005

Looking at this question from the standpoint:

Which patient is most critically ill/injured and if you don't send them to the hospital FIRST they will be dead?

See what your answer will now be....I'll check back later with my answer/rationale.

sjt9721, BSN, RN · Jul 27, 2005

But this is a disaster/emergency question. This is not your typical "you come on shift and which of these patients do you see first". In disasters you help the most stable patient first so that they can assist you.

I respectfully disagree with your statement. Yes, it is a disaster/emergency question. I'm sure you know that triage means "to sort", a term can be used outside of the hospital setting and not just when "you come on shift...".

MCIs require rapid triage of patients to determine the order of treatment, or who gets "sent" first. Determining who of the patients can help you is not a priority in these situations.

I won't argue that the "walking wounded" may be able to assist, but that should not determine patient priority.

Home Health Columnist / Guide · Jul 28, 2005

using these articels as reference, what would your answer be?

prioritizing and delegating in a disaster

internal and external disaster scenerios

http://caring4you.net/disaster.html

from nursing center.com:

a primer on triage and mass casualty events

traditional triage of patients is based on giving care to the most critically ill persons first. in a disaster situation or mass casualty event, the type of triage used would change from caring for the most ill first to caring for those most likely to survive first. this change is related to the scarcity of healthcare personnel and resources in a situation where thousands of persons would be ill or injured. mass casualty collection points would be the site of triage to prevent hospitals from being overrun by patients.

http://www.nursingcenter.com/prodev/ce_article.asp?tid=426163

question (disaster/emerg.)
which one would you send to get medical help first:
1. 70 y.o. man in glaskov coma level 13
2. man with a possible collapsed one lung and exacerbations on the same side
3. screaming teenager with broken leg (open fracture)
4. 4 y.o. boy pulseless, non-breathing, with dried blood

----------------------

pivital word "send to get medical help". phrase can be restated to "send to get medical care".

looking at this from a disaster/mass casualty situation

treat the people who have greatest chance for survival. (1,2,3)

one needs to know the glascow coma score system (higher the number, most neuro intact) 13 out of possible 15, pretty good score so 1 can wait a while.

those pulseless, not breathing, dried blood (think congealed) are signs of death. (#4 sent last).

screeming with broken leg--no airway issues, open fracture can wait 1--2 hours for treatment even with pain.

collapsed lungs are treatable but need immediate intervention to prevent respiratory arrest. {#2)

so i'd triage and send for medical care:

first: #2

second: #3

third: #1

fourth: #4

now if the question means:

out of these four persons who are with you do you send to summon medical help to the scene?

2,3,4 all not moving due to imjuries, so #1 would be sent to summon medical help.

in these days of cell phones, most likely moot point and you'd want the least injured person to assist you.

i would have looked to the question above this one to see if it shead any light on what they were asking for...

awaiting other answers

sjt9721, BSN, RN · Jul 28, 2005

Karen,

That's why I had initially questioned the question. The wording (as posted) is a bit ambiguous. You do well to illustrate the possible meanings in your above post!

sjt

Purlple · Jul 28, 2005

Karen,
That's why I had initially questioned the question. The wording (as posted) is a bit ambiguous. You do well to illustrate the possible meanings in your above post!
sjt

That's true about NCLEX questions. A lot of them ambiguous and we have to try to read into what would they really mean to ask. Also, just a thought...I checked Glasgow 13 and it can be as "inappropriate words" that gives you that score. If I had only one space in ambulance I would not use it for 70 y.o. with "inappropriate words" (could not be an emergency) but for 42 y.o. with a one lung injury.

hollyster · Jul 28, 2005

Airway is always priority.

DLRN · Jul 28, 2005

It was one answer question (not filling in space type). It was worded as "to send" to get medical help. I re-read every question before answering and tried to visualise it. So, all of them were assessed (no pulse, Glascow 13, etc) and it's up to you (or soft of...) which one to send first to get help.
I can't wait to get my results. I had so many priority and delegation that I can't simply check with a text.

We must have taken the test at the same time on the same day,your first posting was one of the same questions I had on mine and so is this one.Mine was filled with delegation and "a nurse is teaching a test in infection contol"it was crazy

wonderbee, BSN, RN · Jul 28, 2005

I'm probably wrong about this because I'm the only one who's thinking this, but isn't the patient with one functioning lung in less danger than the screaming teenager with the open fracture? Doesn't the open fracture of a large bone pose an immediate danger of hypovolemic shock from insanguination?

Purlple · Jul 28, 2005

I'm probably wrong about this because I'm the only one who's thinking this, but isn't the patient with one functioning lung in less danger than the screaming teenager with the open fracture? Doesn't the open fracture of a large bone pose an immediate danger of hypovolemic shock from insanguination?

I think the collapsed lung will cause deviation or shifting of the heart on one side because it will be an empty place there. Also, the other lung will shift as well. It may cause all sort of cardiac, circulatory (think about deviated aorta) and pulmonary problems. I think an open fracture does not necessarily mean patient has damaged artery even so it's bleeding. This is only my guess.