In a disaster, you will prioritize your management and attend first to the patient who is:

GMCH - 2016

Medical Surgical Nursing

Hard

Appeared in: GMCH - 2016

Explanation

In disaster triage, the primary goal is to save the maximum number of lives by prioritizing patients with life-threatening but treatable conditions.
The ABC (Airway, Breathing, Circulation) framework is used for rapid assessment. Any condition compromising breathing is a top priority.
A patient with breathlessness and flail chest has a severe, life-threatening impairment of breathing ('B').
This condition can lead to rapid deterioration and death from hypoxia but is often reversible with immediate medical intervention, such as oxygen therapy and chest stabilization.
Therefore, this patient is classified as 'Immediate' or 'Red Tag' and must be attended to first.

Option A: A fracture of the tibia, while painful and serious, does not pose an immediate threat to life. The patient's airway, breathing, and circulation are stable.
Option B: In a disaster scenario, a patient in a deep coma with a massive head injury has a very poor prognosis and a low chance of survival, even with immediate and intensive care. Allocating limited resources to this patient would likely not change the outcome and would take away resources from more salvageable patients.
Option D: A scalp hematoma in a conscious patient is a minor injury. It is not life-threatening and does not compromise the ABCs.

Clinical Relevance

Nursing practice connection: Use the key finding related to Disaster Triage and Prioritization to guide bedside assessment, documentation, and the next nursing action.
Disaster triage is a core competency for nurses, requiring them to make rapid, difficult decisions to maximize patient survival under high-stress, resource-limited conditions.
The principle of prioritizing salvageable, life-threatening injuries over non-life-threatening injuries or those with a very poor prognosis is fundamental to all mass casualty incident (MCI) response protocols.
What if? If the patient with the flail chest was found to be apneic (not breathing), the START protocol dictates opening the airway. If breathing does not resume, they would be triaged as 'Expectant' (Black). If breathing starts, they are triaged as 'Immediate' (Red).

How to Approach the Question

First, identify the question as a prioritization problem set in a 'disaster' context. This signals that standard one-on-one care rules do not apply; instead, mass casualty triage principles are key.
Recall the fundamental principle of disaster triage: 'do the greatest good for the greatest number.' This means prioritizing patients who are critically injured but have a high chance of survival with immediate care.
Apply the ABC (Airway, Breathing, Circulation) framework to evaluate each option.
Analyze Option A (fracture): This affects mobility and causes pain but is not an immediate ABC threat. Classify as Delayed (Yellow).
Analyze Option B (massive head injury, deep coma): This patient has a very poor prognosis in a disaster setting. Classify as Expectant (Black).
Analyze Option C (breathlessness, flail chest): This is a direct, life-threatening compromise of 'Breathing'. It is salvageable with intervention. Classify as Immediate (Red).

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 pp. 114-116, 120-122