Mark Klimek Prioritization
Which pt should you see first WITHOUT USING ABC’S
o Each option will have
Age (41 year old)
Gender (female)
Diagnosis (with HTN)
Modifying phrase (presents with severe chest pain)
a Age & Gender DO NOT MATTER ignore them
a Modifying phrase is MORE important than the diagnosis
* EXAMPLE: angina prectoris vs myocardial infarction
MI is higher priority
BUT if you add modifiable phrases to them, it could
change that!
Angina with unstable vital signs VS MI with
stable vital signs
o Acute VS chronic acute is higher priority
EXAMPLE:
a COPD
a CHF
a APPENDICITIS BECAUSE ITS ACUTE & THE OTHERS ARE CHRONIC
o Fresh post op (first 12 hrs) VS medical or other surgical
EXAMPLE
a CODP
a CHF
a Acute appendicitis
a 2nd post op day CABG
a 2 hr post op cholecystectomy fresh post op
a Bilateral above the knee amputee
a Right frontal craniotomy
o Unstable VS stable
Stable
a Use of the word stable
a Chronic illness
a Post op >12 hours
a Local or regional anesthesia
a Lab abnormalities of A or B level
a “Ready for discharge, to be discharged”
a Admitted longer than 24hrs
a Unchanged assessments
a Expected s/s of their dx does NOT matter how severe the sx is, they
are STABLE if its expected s/s
, Unstable
a Acute illness
a Post op <12 hrs
a General anesthesia but only in the 1st 12hrs
a Lab abnormalities of C or D level
a “not ready for discharge”
a “newly admitted”
a “newly diagnosed”
a Admitted <24 hrs ago
a Status change changes assessment finding
a Unexpected s/s
EXAMPLE
a 16 yo female w/ meningococcal meningitis who has had a temp of
103.8 since admission 3 days ago
* Meningococcal meningitis acute high priority
* Modifiable phrase: “who has had” = unchanged status low
priority
* Temp EXPECTED (does NOT matter how severe) low
priority
* Admission = 3 days ago >24hr = low priority
a 67 yo male w/ IBS who spiked a temp of 100.3 this afternoon
* IBS chronic low priority
* Modifiable phrase “spiked temp this afternoon” <24hr =
high priority
* Temp w/ IBS dx unexpected high priority
* Changed status high priority
o 4 things that are ALWAYS unstable, regardless if its expected or not
Hemorrhage do NOT confuse this with bleeding
High fever over 105 seizure
Hypoglycemia
Pulselessness or breathlessness
a @ the scene of an unwitnessed accident = lowest priority they are
already dead
a If it was witnessed accident, then they are highest priority
o Black tag @ scene unwitnessed accident
Pulselessness
breathlessness
Fixed & dilated pupils, even if they are breathing & have a pulse
Which pt should you see first WITHOUT USING ABC’S
o Each option will have
Age (41 year old)
Gender (female)
Diagnosis (with HTN)
Modifying phrase (presents with severe chest pain)
a Age & Gender DO NOT MATTER ignore them
a Modifying phrase is MORE important than the diagnosis
* EXAMPLE: angina prectoris vs myocardial infarction
MI is higher priority
BUT if you add modifiable phrases to them, it could
change that!
Angina with unstable vital signs VS MI with
stable vital signs
o Acute VS chronic acute is higher priority
EXAMPLE:
a COPD
a CHF
a APPENDICITIS BECAUSE ITS ACUTE & THE OTHERS ARE CHRONIC
o Fresh post op (first 12 hrs) VS medical or other surgical
EXAMPLE
a CODP
a CHF
a Acute appendicitis
a 2nd post op day CABG
a 2 hr post op cholecystectomy fresh post op
a Bilateral above the knee amputee
a Right frontal craniotomy
o Unstable VS stable
Stable
a Use of the word stable
a Chronic illness
a Post op >12 hours
a Local or regional anesthesia
a Lab abnormalities of A or B level
a “Ready for discharge, to be discharged”
a Admitted longer than 24hrs
a Unchanged assessments
a Expected s/s of their dx does NOT matter how severe the sx is, they
are STABLE if its expected s/s
, Unstable
a Acute illness
a Post op <12 hrs
a General anesthesia but only in the 1st 12hrs
a Lab abnormalities of C or D level
a “not ready for discharge”
a “newly admitted”
a “newly diagnosed”
a Admitted <24 hrs ago
a Status change changes assessment finding
a Unexpected s/s
EXAMPLE
a 16 yo female w/ meningococcal meningitis who has had a temp of
103.8 since admission 3 days ago
* Meningococcal meningitis acute high priority
* Modifiable phrase: “who has had” = unchanged status low
priority
* Temp EXPECTED (does NOT matter how severe) low
priority
* Admission = 3 days ago >24hr = low priority
a 67 yo male w/ IBS who spiked a temp of 100.3 this afternoon
* IBS chronic low priority
* Modifiable phrase “spiked temp this afternoon” <24hr =
high priority
* Temp w/ IBS dx unexpected high priority
* Changed status high priority
o 4 things that are ALWAYS unstable, regardless if its expected or not
Hemorrhage do NOT confuse this with bleeding
High fever over 105 seizure
Hypoglycemia
Pulselessness or breathlessness
a @ the scene of an unwitnessed accident = lowest priority they are
already dead
a If it was witnessed accident, then they are highest priority
o Black tag @ scene unwitnessed accident
Pulselessness
breathlessness
Fixed & dilated pupils, even if they are breathing & have a pulse
