ATLS 10TH EDITION Answers
for
Appendix F: Triage Scenarios
Go back to last viewed page 647
,648 SECTION 4 ■ Student Course
triage scenario i
Mass Shooting at a Shopping Mall
You are summoned to a safe triage area at a shopping mall where 6 people are injured in a mass shooting. The
shooter has killed himself. You quickly survey the situation and determine that the patients’ conditions are as
follows:
PATIENT A—A young male is screaming, “Please help me, my leg is killing me!”
PATIENT B—A young female has cyanosis and tachypnea and is breathing noisily.
PATIENT C—An older male is lying in a pool of blood with his left pant leg soaked in blood.
PATIENT D—A young male is lying facedown and not moving.
PATIENT E—A young male is swearing and shouting that someone should help him or he will call his lawyer.
PATIENT F—A teenage girl is lying on the ground crying and holding her abdomen.
1. For each patient, what is the primary problem requiring treatment? The student(s) should indicate that
managementprioritiescouldbebasedoninformationgleanedbysurveyingallofthevictimsfromadistance. If
the student indicates that he or she needs to examine each of the patients individually before making a decision,
the groupshoulddiscussthis response. Thedirection of the discussionshouldindicate that, while information is
being obtained on one patient, another patient might die from a more serious injury. Also, the time taken
to gather detailed information on all of the patients before establishing priorities based on that
information could lead to disastrous results. If there is doubt about which one of these patients is most
severely injured, based on the available information, the decision must be made to proceed with the best
information available at the time. The instructor should then provide information that could be obtained
by surveying the situation from a distance, as follows:
PATIENT A—is a young male screaming, “Please help me, my leg is killing me!”
Possible Injury/Problem:7KH SDWLHQW KDV D SUREDEOH IUDFWXUH RSHQ IUDFWXUH RI WKH ORZHU H[WUHPLW\
, PATIENT B—appears to have cyanosis and tachypnea and is breathing noisily. Possible
Injury/Problem:7KLV SDWLHQW OLNHO\ KDV D FRPSURPLVHG DLUZD\
PATIENT C—is an older male lying in a pool of blood with his left pant leg soaked in blood. Possible
Injury/Problem:7KLV SDWLHQW KDV SRWHQWLDO EORRG ORVV IURP DQ RSHQ IUDFWXUH RU ODFHUDWLRQ
PATIENT D—is lying facedown and not moving.
Possible Injury/Problem:7KLV SDWLHQW PD\ EH FRPDWRVH GHDG RU KDYH D EUDLQ RU VSLQH LQMXU\
PATIENT E—is swearing and shouting that someone should help him or he will call his lawyer.
Possible Injury/Problem: ,V WKLV SDWLHQW KHPRG\QDPLFDOO\ QRUPDO" 7KLV SDWLHQW PD\ EH LQ VKRFN KDYH D
SV\FKRORJLFDO SUREOHP RU D SHUVRQDOLW\ GLVRUGHU
PATIENT F—A teenaged girl is lying on the ground crying and holding her abdomen.
Possible Injury/Problem:'RHV WKLV SDWLHQW KDYH D WRUVR JXQVKRW LQMXU\"
The instructor should clearly explain that all of the previously outlined information could be obtained without
actually examiningany of thesepatientsin detail and that, basedon this information, a triagedecision could be made.
The instructor may ask, “Suppose you are in doubt about which patient is most severely injured. How should you
respond?” Students should be prompted to respond that the decision must be made to proceed on the basis of
the best information available at the time.
Based on the information obtained by surveying the patients from a distance, the students are then asked to
triage the victims and give the rationale for their choices. The convergent or divergent model may be used here to
facilitate the discussions.
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, PART B ■ Answers for Appendix F: Triage 3
triage scenario i
2. Establish the patient priorities for further evaluation by placing a number (1 through 6, where 1 is the highest
priority and 6 is the lowest) in the space next to each patient le er.
5 Patient A
1 Patient B
3 Patient C
2 Patient D
6 Patient E
4 Patient F
3. Briefly outline your rationale for prioritizing the patients in this manner. The instructor leads the discussion
by asking the students to give the rationale for their priority choices, and these answers are discussed
among the students. At the end of the discussion, the students should arrive at the following priorities:
NOTE: Patients B and D may be interchanged as Priorities 1 and 2, and both may be considered high priority.
However, the rationale must be given by the student—for example, Patient D may have a major airway problem
as well. The reason for determining that patients B and D are higher priorities than patient C is that they
appear to have airway and breathing problems, whereas patient C appears to have circulatory problems related
to hemorrhage. Also, Patients A and E may be considered low priority.
PRIORITY PATIENT RATIONALE
1 B – Airway The patient apparently is not talking. Her respiratory e orts are rapid, and
compromise thereisevidenceofanobstructedairway(breathingnoisily).Thecyanosisis
additional information supporting respiratory compromise.
2 D – Coma/brain/ With the patient lying facedown and not moving, it must be assumed that he or
spine injury/ she is comatose, has a spine injury, or is dead. Had the patient been awake and
for
Appendix F: Triage Scenarios
Go back to last viewed page 647
,648 SECTION 4 ■ Student Course
triage scenario i
Mass Shooting at a Shopping Mall
You are summoned to a safe triage area at a shopping mall where 6 people are injured in a mass shooting. The
shooter has killed himself. You quickly survey the situation and determine that the patients’ conditions are as
follows:
PATIENT A—A young male is screaming, “Please help me, my leg is killing me!”
PATIENT B—A young female has cyanosis and tachypnea and is breathing noisily.
PATIENT C—An older male is lying in a pool of blood with his left pant leg soaked in blood.
PATIENT D—A young male is lying facedown and not moving.
PATIENT E—A young male is swearing and shouting that someone should help him or he will call his lawyer.
PATIENT F—A teenage girl is lying on the ground crying and holding her abdomen.
1. For each patient, what is the primary problem requiring treatment? The student(s) should indicate that
managementprioritiescouldbebasedoninformationgleanedbysurveyingallofthevictimsfromadistance. If
the student indicates that he or she needs to examine each of the patients individually before making a decision,
the groupshoulddiscussthis response. Thedirection of the discussionshouldindicate that, while information is
being obtained on one patient, another patient might die from a more serious injury. Also, the time taken
to gather detailed information on all of the patients before establishing priorities based on that
information could lead to disastrous results. If there is doubt about which one of these patients is most
severely injured, based on the available information, the decision must be made to proceed with the best
information available at the time. The instructor should then provide information that could be obtained
by surveying the situation from a distance, as follows:
PATIENT A—is a young male screaming, “Please help me, my leg is killing me!”
Possible Injury/Problem:7KH SDWLHQW KDV D SUREDEOH IUDFWXUH RSHQ IUDFWXUH RI WKH ORZHU H[WUHPLW\
, PATIENT B—appears to have cyanosis and tachypnea and is breathing noisily. Possible
Injury/Problem:7KLV SDWLHQW OLNHO\ KDV D FRPSURPLVHG DLUZD\
PATIENT C—is an older male lying in a pool of blood with his left pant leg soaked in blood. Possible
Injury/Problem:7KLV SDWLHQW KDV SRWHQWLDO EORRG ORVV IURP DQ RSHQ IUDFWXUH RU ODFHUDWLRQ
PATIENT D—is lying facedown and not moving.
Possible Injury/Problem:7KLV SDWLHQW PD\ EH FRPDWRVH GHDG RU KDYH D EUDLQ RU VSLQH LQMXU\
PATIENT E—is swearing and shouting that someone should help him or he will call his lawyer.
Possible Injury/Problem: ,V WKLV SDWLHQW KHPRG\QDPLFDOO\ QRUPDO" 7KLV SDWLHQW PD\ EH LQ VKRFN KDYH D
SV\FKRORJLFDO SUREOHP RU D SHUVRQDOLW\ GLVRUGHU
PATIENT F—A teenaged girl is lying on the ground crying and holding her abdomen.
Possible Injury/Problem:'RHV WKLV SDWLHQW KDYH D WRUVR JXQVKRW LQMXU\"
The instructor should clearly explain that all of the previously outlined information could be obtained without
actually examiningany of thesepatientsin detail and that, basedon this information, a triagedecision could be made.
The instructor may ask, “Suppose you are in doubt about which patient is most severely injured. How should you
respond?” Students should be prompted to respond that the decision must be made to proceed on the basis of
the best information available at the time.
Based on the information obtained by surveying the patients from a distance, the students are then asked to
triage the victims and give the rationale for their choices. The convergent or divergent model may be used here to
facilitate the discussions.
Goback to last viewed page
, PART B ■ Answers for Appendix F: Triage 3
triage scenario i
2. Establish the patient priorities for further evaluation by placing a number (1 through 6, where 1 is the highest
priority and 6 is the lowest) in the space next to each patient le er.
5 Patient A
1 Patient B
3 Patient C
2 Patient D
6 Patient E
4 Patient F
3. Briefly outline your rationale for prioritizing the patients in this manner. The instructor leads the discussion
by asking the students to give the rationale for their priority choices, and these answers are discussed
among the students. At the end of the discussion, the students should arrive at the following priorities:
NOTE: Patients B and D may be interchanged as Priorities 1 and 2, and both may be considered high priority.
However, the rationale must be given by the student—for example, Patient D may have a major airway problem
as well. The reason for determining that patients B and D are higher priorities than patient C is that they
appear to have airway and breathing problems, whereas patient C appears to have circulatory problems related
to hemorrhage. Also, Patients A and E may be considered low priority.
PRIORITY PATIENT RATIONALE
1 B – Airway The patient apparently is not talking. Her respiratory e orts are rapid, and
compromise thereisevidenceofanobstructedairway(breathingnoisily).Thecyanosisis
additional information supporting respiratory compromise.
2 D – Coma/brain/ With the patient lying facedown and not moving, it must be assumed that he or
spine injury/ she is comatose, has a spine injury, or is dead. Had the patient been awake and
