1. Clinical Foundations Priority Setting and Patient Assessment

2. Primary Survey Assessment of Airway/Cervical Spine, Breathing, Circulation, and Disability ◦ Subjective Data-Chief Complaint, precipitating event/onset of symptoms, mechanism of injury, time factor, source of data ◦ Objective Data-physical signs and symptoms

3. Airway Airway/Cervical Spine – open/clear or Obstructed Is it patent? Position the airway, maintain cervical immobilization, remove debris, possibly inert NP/OP airway

4. Breathing Is it acceptable or compromised Position, provide supplemental oxygen, auscultate breath sounds, provide PPV or intubate if necessary

5. Circulation Pulse, Bleeding, Perfusion Iv access, auscultate heart sounds, CPR, control bleeding, IVF or blood products

6. Disability Brief Neuro exam

7. Secondary Survey 90 second head to toe examination The goal is to discover abnormalities and injuries

8. Focused Assessment System specific related to complaint Contains subjective and objective data Intervention performed

9. Vital Signs Temp-abnormally high or low should be confirmed with rectal Pule-rate, quality, cap refill, compared to each side of the body Respirations, rate and work of breathing Oxygen Saturation-essential for respiratory complaints, altered LOC, serious illness, or any abnormal vital sign Blood Pressure-Systolic is a component of cardiac output, Diastolic is a component of vasculature Orthostatic Vital Signs-syncope, dizzy, dehydration- Lying, Sitting, Standing. Positive if an increase in heart rate greater than 20-30 bpm or if dizziness or syncope develops during

10. Prioritization with Individual Patients Assess BEFORE acting Prioritization Principles ◦ Acute before Chronic ◦ Life before Limb ◦ Systemic before Local

11. Trends Any symptoms associated with other definitive changes (e.g. not feeling well and a fever and feeling short of breath) Any minor symptoms that tend to recur repeatedly or intensify in severity (nagging cough that won’t go away) Steady progressive decline

12. Patient Demographics Presence of other risk factors increase the patient’s priority Elderly Very Young Altered Immunity Transplant Patients Multiple Comorbidities Pregnancy Reactions that have the potential to worsen (overdose, allergic response)

13. Remember A “known” patient can develop a new problem Avoid WHO rather than what Just because someone is more demanding or “ranked” higher should not distract from a more urgent patient need Express your limit…”I understand you need me. I have to take care of this urgent need first and then a I can work with you”

14. And finally… Remember, prioritization does not mean a person’s need is not met. It is first things first so the right care is given to the right person at the right time for the right reason.