Question about triage

I'm a brand new nursing student and we haven't even covered the nursing process yet, but using critical thinking here is what I think: the pt with crushing chest pains might be showing signs of an MI or other heart condition. However, the gunshot wound pt is likely losing blood at a steady rate with an open wound that could easily become infected, not to mention damage to the visceral organs. Seems like he would be in need of more immediate attention.

Hopefully an experience nurse can correct me.

You need to get more information! A GSW could be anything from a BB Gun to an AK-47 so depending on where the patient was shot, what type of gun was used, are they breathing or has CPR commenced, can they walk etc VS crushing chest pain should always be treated as an MI which is a priority 1. You can't do triage based on the fact on has a GSW and the other has crushing chest pain! You need Vitals taken in the field to determine which to treat first!

I would also say more information is needed. You have to look at the whole picture as opposed to just the CC.

What are the vitals? Is the bleeding controlled on the GSW?

If the GSW is actively and heavily bleeding, the blood pressure is in the toilet, and patient is going into shock, then that is a trauma priority.

At the same time, if the CCP has a monitored strip that is all over the place, a shockable rhythym, about to code on you, then that is a priority.

I would say that both, depending on the circumstances and the initial assessment would need priority--so you would need to call a trauma team and a rapid response team (use your available team mates).

If, due to assessment, vitals, etc. either one is a lesser priority ie: the "crushing chest pain" has been given nitro with relief by EMS, the GSW is a BB gun to the hand, whatever--then the more unstable the higher the priority.

Be careful not to base your prioritizing at triage on CC alone.

This complicates as to what the correct "nursing school answer" is. Who has airway compromise? Who is actively bleeding? It was always ABC's now it is CAB's--So circulation is first. On that aspect, can the answer be both without further information as to condition?

Let us know what the correct answer ends up being....

Oh, and another thought. Always use your critical thinking skills. Do not try to manage both alone. Get your charge RN involved in this double whammy. Know what resources you have. Be prepared that both of these patients are unstable and you need assistance.

This isn't a question about what evals each of these folks need and why they might present various differential diagnoses, it's a question about how you use your critical thinking skills to make a decision. In part, it's to let your faculty know if they've been effective in explaining prioritizing to you, whether you remember your anatomy and physiology, and how well you communicate your assessment.

So. You have two people before you, and no other information of any kind.

While the GSW may be at risk for an infection or surgical repair of injured organs, infection sure as hell isn't going to kill him right now, and you don't know whether he has a serious intra-abdominal injury or not because they haven't told you.

Crushing chest pain is med-speak for "myocardial infarction in progress," a bona fide emergency and de facto move-to-the-head-of-the-line criterion absent any other info. You have no info on treatment that's been given in the field, so you can't assume there was any; he might just have walked in your triage area off the street.

As noted, that "GSW" could be minor or it could be a hole in the abdominal aorta. If they don't tell you VS for each in a question like this, you pick the patient you can say for sure is having a baaaaad thing, and that's the "crushing" chest pain.

Thanks for all the feedback, made it a lot clearer.

This is one of those questions where I hope no Nurse in real life would actually be answering the question with the lack of information involved, they would be getting more information, they also wouldn't be deciding to treat only one of these patients at a time.

In real practice and without any more information though, the gun shot wound comes first. The gun shot wound is a trauma code as soon as they come in the door, while the crushing chest pain might eventually become a cath code, crushing chest pain alone doesn't make someone a cath code, they still need a 12 lead. You'll order a 12 lead for the chest pain and deal with the GSW while that's being done.

Maybe it's because it's more routine, even with a positive STEMI by 12 lead I still feel more comfortable with a STEMI than a gunshot wound. If needed, I can do CPR all the way to the cath lab without expecting any big problems. With a GSW, CPR won't circulate blood that's drained out onto the floor. In terms of what' more likely to be life threatening, "crushing" chest pain or abdominal GSW, GSW is more likely to be life threatening. We track our ER triages by CC, symptoms "likely" to suggest an AMI (not just "chest pain" but true classic AMI symptoms) turn out to be cardiac in origin less than 25% of the time. While we don't track the percentage of GSW's that turn out to be non-serious, in my experience it's the minority that are surprisingly benign.

Neither are something you want, but a GSW in an area with significant blood flow and volume to bleed into will kill you quicker than an MI will.

If it is a serious gunshot wound, we would be calling a code "yellow" and a trauma priority or whatever they call it. Meaning we would get more people in the department plus get the surgery resident and the attending called. The doctor and at least two ER nurses would go with that one along with the lab phleb, an ICU nurse, and the house supervisor.

One to two nurses and a pct would probably triage the crushing chest pain with the 12 lead, vitals, and get an IV in the mean time.