Prioritization of Multiple Patients Using the ABCDE Approach

Scenario

You receive four new patients during a shift handover:

1. COPD patient on 2 L nasal cannula, now confused.
2. Post-op cholecystectomy patient complaining of severe pain (8/10).
3. Diabetic patient with BG 42 mg/dL, drowsy.
4. Pneumonia patient with SpO₂ 86% on 4 L, frothy sputum.

Question: Who will you assess first and why?

Best Practice Answer

1. Apply the ABCDE framework:
   • Airway: assess for obstruction or ineffective breathing.
   • Breathing: patient 4 shows potential pulmonary edema → highest priority.
   • Circulation: diabetic hypoglycemia (patient 3) next critical.
2. Immediate interventions:
   • Sit patient 4 upright, increase O₂, call for rapid assessment, prepare furosemide/Nitro per order.
   • Give IV dextrose or D50 for patient 3.
3. Delegate & communicate:
   • Assign vitals check to CNA; notify charge nurse; SBAR to provider.

Evaluation focus: Prioritization reasoning (40%), safety (40%), delegation (20%).