Which should be seen first?

In reality, I'd see the chest pain patient first due to possible MI and the need for fast door to balloon time

Could go either way depending on the age of the pt, VS, and history. If both are equally critical my ER would make room for both, if any delay (room being cleaned, pt being moved) I would get the EKG, start the line get the labs and put O2 on the pt. I can even get an updraft ordered for the SOB if their symptoms indicate the need for one.

Toq

In my interview I had the question severe chest pain or asthma attack, and asthma attack was correct. My interviewer did say that to keep in mind that in the fast paced ER setting that I would probably be getting interventions started for both patients simultaneously. (i.e. having the tech put the chest pain pt on a monitor and phlebotomy to draw labs while I got nebs started for asthma.)

You will never be wrong if you follow the ABCs and give the rationale for it. Even ACLS will follow the ABCs for a CP patient.

to me Sob doesnt translate to "cant breathe".....more info needed

to me Sob doesnt translate to "cant breathe".....more info needed

I agree. There is a HUGE difference between SOB and an asthma attack.

On the CEN the answer is always ABC's but in real life it would depend on how SOB and the other details previously mentioned (age, hx etc).

Both are probably 2's and let the charge nurse know they both need to come back, get a neb and an EKG in triage if able...

You have to look at the patient to make that call.

chest pain can be an MI or I've had a cough for four days or I've pulled a muscle shoveling the driveway. Are they 25 or 95. Are they pink and laughing or grey and diaphoretic

Short of breath can be a simple cold or an exacerbation of COPD that needs intubated now.

In my ER, part of triaging is doing an "across the room assessment" where you are basically eyeballing all of the patients to observe for any acute distress pts that you would see first, also we are a chest pain and stroke center so from the door to EKG must be within 15min. i believe. ABC's do say airway first, however, SOB can be very subjective, if i'm looking at the pt with SOB and they're resp rate is even and regular, they're skin looks normal color, i'm not hearing stridor/wheezes etc and they don't look as if they'll code on you right then and there, i'm not gonna necessarily see them over a crushing chest pain pt who is pale, diaphoretic, weak, etc. the challenge of triage is not necessarily going by the textbook but going by the presentation of the patient. i hope that helped answer your question. :redbeathe

It's always A,B,C,D priority....

THEN after finding out what letter corresponds to your pt's problem, you decide if it is a "potential" or "active" abnormality.

THEN if it is an "active" problem is it IMMEDIATE, URGENT or DELAYED

So your HIGHEST possible triage would be

"Active" airway obstruction,

LOWEST would be "potential" concussion ("D" for neuro)

Another way to look at it would be:

An ACTIVE-IMMEDIATE Circulation ("C") problem (no pulse)is a higher priority than a POTENTIAL-URGENT Airway problem (epiglottitis child)

The ENA ENPC course teaches a pretty critical/analysis "triage" type skill station. I find I have to break it down simple like this to students when we teach it.

Hope this helps!