Which should be seen first?

Specialties Emergency


Question: Two pts come into the ER, which pt needs to be seen first: Pt complaining of SOB or pt complaining of severe chest pain. I'm preparing for an interview and thought of this question. I know I need to think of ABC's so i'm leaning towards choosing the patient with SOB. thanks!


310 Posts

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


128 Posts

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.


allnurses Guide

ghillbert, MSN, NP

3,796 Posts

Specializes in CTICU.

What is an "updraft"?


16 Posts

Specializes in ED!!.

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.)


1,446 Posts

Specializes in ED, ICU, PACU.

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.

morte, LPN, LVN

7,015 Posts

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


310 Posts

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

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

allnurses Guide

Spidey's mom, ADN, BSN, RN

11,304 Posts

What is an "updraft"?

One of the things that surprised me when I first joined allnurses was the different terminology for the same things. Then I noticed it when we had new people hired from other parts of the country.

I think "updraft" means a breathing treatment.

Also called a nebulizing treatment.

Nurses do that at our small hospital.


Larry77, RN

1,158 Posts

Specializes in Trauma/ED.

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...


229 Posts

Specializes in OB, ER.

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.

Specializes in Emergency/Trauma/Critical Care Nursing.

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

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