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MARK KLIMEK LECTURE NOTES

Lecture 12 Prioritization

1) Which patient is sickest or healthiest-disaster

• ex. in your town and you need to discharge to make room
• you receive report on 4 pts, which would you go to first

2) 4 parts: age, gender, diagnosis and modifying phrase (age and gender are not

important but is important in peds) 3) Diagnosis is important + modifying phrase (more important)

• if pt had angina pectoris vs. myocardial infarction- who is the highest

priority?- with unstable BP/with stable vital signs – ANGINA because he has unstable BP HIGH priority

1) Acute beats chronic- much higher priority

• COPD, CHF, appendicitis (highest priority because its acute)

2) Fresh Post op (12 hours) beats medical or other surgical

• COPD, CHF, 2 day by pass graft, 2 hour post choley (most important

because fresh post op), radical neck dissection, bilateral above the knee above the knee amputation 3) Unstable beats stable-

a. Words that count for stability: stable, chronic illness, post op greater

than 12 hours, local or regional anesthesia, lab abnormalities of an A or B level, phrases ready for discharge, to be discharge or admitted longer than 24 hours ago, unchanged assessments nothing new,

b. Words that count for instability: unstable, acute illness, post op less

than 12 hours, general anesthesia in the first 12 hours, lab abnormalities of a C or a D, not ready for discharge, newly admitted, newly diagnosed or admitted less than 24 hours ago, changing or changed assessment,

• Patient is stable if they are experiencing the typical expected signs

and symptoms of the disease with which they were diagnosed

• Patient is unstable if they are experiencing unexpected signs and

symptoms of the disease with which they were diagnosed

Examples: who is the highest priority

-16 yr old F with meningiccocal meningitis 103.8 deg for 3 day (usually high priority because its acute, “who has had”- unchanged… puts in lower priority, high temperature expected putting her at low priority, she was also admitted less than 1 / 2

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24 hours ago making her even lower) – she can go home with IV antibiotic -Male with IBS who spiked a temp of 100.3 this afternoon (usually low priority because its chronic, higher priority because it’s a new temperature (SPIKED) and not expected with IBS)- he cannot go home because he has a symptom that’s out of the ordinary

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