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A fire due to kerosene stove explosion has involved a house. The victims are directly to a
small hospital nearby the house (about 1 km). The 5 patients are all members of the same
family, and arrive at the emergency department. They are:
Patient A : A 40-year-old woman is pale and complaining of pain in his hip
spontaneously. There are clinical signs of fracture with abdominal distention and
tenderness to palpation. There are blister and erythemaof the posterior chest, back, and
thighs. A laceration at her forehead is also seen. Vital signs; RR 24 bpm, HR 96 bpm, and
BP 140/90 mmHg.
Patient B : A 20-year-old woman is feeling pain when her left upper arm and leg are
There is no obvious deformity of the arm, but the thigh is swollen in a traction splint.
Vital signs:
RR 30 bprn, HR 120 hpm, and BP 150/90 mml-lg.
Patient C : A 53-year-old woman is coughing and expectorating black sputum. Her voice
is clear and she is feeling pain in both hands, which show erythema and blisters. Hairson
her face and head are burned. Vital signs: RR 34 bpm, HR 110 bpm, and BP 140/90
Patient D : A 7-year-old boy is crying and seems frightened. He feels pain from blisters
and erytherna over his back, buttocks, and both of posterior legs. Vital signs: RR 24 bpm,,
HR 100 bpm, BP 100/70 mmHg
Patient E : An 80-year-old man is coughing and expectorating black sputum. An
expiratory wheezing can be heard from his chest by stethoscope. His voice is hoarse and
he responds only to painful stimuli. Burns can be seen at his posterior chest and back and
both of his thigh circumferentially. Vital signs: RR 32 bpm, HR 132 bpm, and BP 90/50
Manage priorities in this scenario based on information obtained by surveying the injured
patients at a distance. Based on the best information available at the time, a decision has
to be made to proceed, although there may be doubt as to which patient Is more injured.
(Proceed to next page)

1. Identify which patient(s) has associated burn trauma and/or inhalation injury in
addition to body surface burns, and place a check in the box next to the patient letter.
2. Using the table provided below:
a. Establish priorities of care In your hospital emergency department by placing a
number (no. 1 through 5, with no.1 being your highest priority and no.5 being your
lowest priority) in the space provided for each patient letter in the column
Treatment Priority.
b. Identify which patient has associated trauma and/or an airway Injury and place a
mark in the appropriate column under Associated
c. Estimate the percent of body surface area (BSA) burn for each patient and enter the
percent for each patient letter in the column % BSA.
d. Identify which patient is transferred to a burn center and/or to a trauma center and
place a mark in the appropriate column under Transfer.
e. Establish your priorities for transfer and enter your priority number under Transfer









You are the only doctor in a community health center emergency department. There are
two nurse available to assist you. About ten minutes ago you were told by phone that the
health center ambulance and an another one from other health center would be arriving
with patients from a single car crash. Two ambulances arrive with 5 patients who were
passengers in a car traveling at 100 km/hour before it crashed. The patients are:
Patient A : A 40-year-old man was the driver. It is told that he was not wearing a seat belt.
When the crash happened, he was thrown against the windscreen. He Is in seyerepiapry
distress. There are several injuries, including: 1) severe maxlliofacial trauma with
bleeding from nose and mouth, 2) an angulated deformity of the right forearm, and 3)
multiple abrasions over the anterior chest wall. Vital signs: RR 42 bpm, HR 124 bpm, BP
160/90 mmHg. GCS score : 9
Patient B : A 35-year-old man passenger was apparently thrown from the front seat and
found 8 meters from the car. On admission, he is awake, alert, but complains of
abdominal and chest pain. On palpating his hips, he complains severe pain and crepitus
related to fracture can be felt. Vital signs: RR 24 bpm, HR 138 bpm, BP 100/80 mmHg.
Patient C : A 7-year-old girl was extricated from the rear seat. She was found alert and
talking. Now she responds to infu, only by crying out. Injuries Include multiple abrasions
and an angulated deformity of the left lower leg. There Is dried blood around her nose
and ear. Vital signs: RR 36 bpm, HR 172 bpm, BP 120/80 mmHg.
Patient D : A 26-year-old woman was extricated from the back seat of the car. She is 8
months pregnant and complains of abdominal pain. She is hysterical. Injuries include
p.eabreslons to her face and anterior abdominal wall. Her abdomen is tender to palpation.
She Is In active labor. Vital signs: RR 26 bpm, HR 100 bpm, BP 150/90 mmHg.
Patient E: : A 28-year-old female passenger was found under the car. On admission, she Is
confused and responds slowly to verbal stimuli. There are multiple abrasions to her face,
chest, and abdomen. Breath_soundsare_absent on the rIeh heithpx, and palpation on her
abdomen feels tenderness. Vital signs : RR 36 bpm, HR 140 bpm, BP 80/50 mmHg.GCS
score: 11

1. Outline the steps you would take to triage these 5 patients:

2. Establish your patient priorities by placing a number (no.1 through no.5, with no.1
being your highest priority and no.5 being your lowest priority) In the space next to
each lettered patient; and briefly outline your rationale for prioritizing these patients In
the manner you did.
Patient A
Priority No. _____
Patient B
Priority No. ______
Patient C
Priority No. _____
Patient D
Priority No._____
Patient E
Priority No.______