Triage Challenges

Round 1 :: Day Shift

Instructions: You are the Triage Nurse at a walk-in clinic. It is a busy Tuesday afternoon. Four patients check in at the exact same time. Rank them from 1 (Most Urgent) to 4 (Least Urgent).

  • Patient A: The “Nervous Student.” Came in because they have a big test tomorrow and their stomach feels “weird.” They are pacing around the waiting room.
    • Vitals: BP 110/70, Pulse 80, Glucose Normal, Pupils Reactive.
  • Patient B: The “Grandma.” She was brought in by her neighbor because she was acting confused and “saying strange things.” She has a history of diabetes.
    • Vitals: BP 90/60 (Low), Pulse 110 (Fast), Glucose over 400.
  • Patient C: The “Weightlifter.” Was doing squats at the gym and felt a pop in their lower back. Now their left leg feels numb and they can’t kick when you tap their knee (absent reflex).
    • Vitals: BP 120/80, Pulse 70, Lungs Clear.
  • Patient D: The “Soccer Player.” Ran off the field coughing uncontrollably. You can hear a whistling sound when they breathe out.
    • Vitals: Pulse 100, Oxygen (SpO_2) 93%, Wheezing heard in lungs.

YOUR RANKING:

  1. (Most Critical): Patient ______
    • Reason: ___________________________________________________
  2. (Serious): Patient ______
  3. (Stable): Patient ______
  4. (Least Critical): Patient ______

Round 2 :: Night Shift

Instructions: It is now 2:00 AM in the Emergency Room. It is quiet until these four patients arrive. Rank them from 1 (Most Urgent) to 4 (Least Urgent).

  • Patient E: The “Dancer.” Tripped during rehearsal. Her ankle is swollen and looks like a grapefruit, but her toes are pink and warm. She is crying because it hurts.
    • Vitals: BP 120/80, Pulse 85, Breathing Normal.
  • Patient F: The “Concert Fan.” Was in a crowded “mosh pit” for 4 hours without water. Fainted and was carried in. Skin feels hot and completely dry (no sweat).
    • Vitals: BP 100/60 (Dropping), Pulse 130, SpO_2 98%.
  • Patient G: The “Handyman.” Fell off a ladder and hit the side of his head on the pavement. He says he feels “sleepy,” and you notice one pupil is much bigger than the other.
    • Vitals: BP 150/90, Pulse 50, Pupils Unequal.
  • Patient H: The “Toddler.” Parents brought him in because he feels hot and is coughing. He is crying loudly (which is a good sign!).
    • Vitals: Temp 101°F, BP 115/75, Oxygen (SpO_2) 97%.

YOUR RANKING:

  1. (Most Critical): Patient ______
    • Reason: ___________________________________________________
  2. (Serious): Patient ______
  3. (Stable): Patient ______
  4. (Least Critical): Patient ______

Round 3 :: The Big Game

Instructions: You are the medic on the sidelines of the Homecoming Game. It is chaos! Four students run up to you at the same time. Rank them from 1 (Most Urgent) to 4 (Least Urgent).

  • Patient I: The “Super Fan.” Drank 4 “Mega-Monster” energy drinks in one hour. Complains of heart racing and nausea.
    • Vitals: Pulse 140, BP 130/85, Alert but jittery.
  • Patient J: The “Band Kid.” Ate a bake sale cookie; didn’t know it had peanuts. Lips are swelling, voice sounds raspy/hoarse.
    • Vitals: Pulse 110, BP 88/50, Wheezing loudly.
  • Patient K: The “Cheerleader.” Landed a backflip wrong. Left arm is bent in a “Z” shape with bone poking through the skin.
    • Vitals: Pulse 110, BP 120/80, Color is pale.
  • Patient L: The “Superstar Quarterback.” Breathing very fast (also called _______) and says “I can’t feel my hands!” after an emotional breakup.
    • Vitals: Pulse 90, Oxygen (SpO_2) 100%, Respiratory Rate 40.

YOUR RANKING:

  1. (Most Critical): Patient ______
    • Reason: ___________________________________________________
  2. (Serious): Patient ______
  3. (Stable): Patient ______
  4. (Least Critical): Patient ______

Round 4 :: The Amusement Park

It is a 95-degree summer day at “Mega-Coaster Mountain.”

  • Patient M: The “Thrill Seeker.” Cut their thigh on a fence. Blood is bright red and spurting in rhythm with their heartbeat.
    • Vitals: Pulse 120, BP 90/50, Pale skin.
  • Patient N: The “Fast Pass.” Diabetic student who skipped lunch. They are sweating, shaking, and mumbling confused words.
    • Vitals: Pulse 110, BP 115/75, Glucose 45.
  • Patient O: The “Coaster Fan.” Banged their head during a loop. They have a headache and feel dizzy, but are oriented.
    • Vitals: Pulse 85, BP 120/80, Pupils Equal and Reactive.
  • Patient P: The “Sunbather.” Fell asleep without sunscreen. Shoulders are bright red and stinging; complains of thirst.
    • Vitals: Pulse 95, BP 110/70, Temp 99.0°F.

YOUR RANKING:

  1. (Most Critical): Patient ______
    • Reason: ___________________________________________________
  2. (Serious): Patient ______
  3. (Stable): Patient ______
  4. (Least Critical): Patient ______

Round 5 :: The Winter Ski Trip

You are the ski patrol medic. A sudden snowstorm has just rolled in.

  • Patient Q: The “Trailblazer.” Lost in the woods for 5 hours. They have stopped shivering and their speech is slurred.
    • Vitals: Pulse 40, BP 85/50, Temp 90°F.
  • Patient R: The “Snowboarder.” Landed hard on their shoulder, which looks deformed and hangs low. Crying in intense pain.
    • Vitals: Pulse 115, BP 130/85. Fingers are warm and pink.
  • Patient S: The “Photographer.” Took goggles off during the storm. Eyes are red, watering, and feel like they contain sand.
    • Vitals: Pulse 80, BP 120/80. Breathing normal.
  • Patient T: The “Hot Cocoa Fan.” Spilled boiling cocoa on their hand. The skin is red and a single blister is forming.
    • Vitals: Pulse 90, BP 115/75.

YOUR RANKING:

  1. (Most Critical): Patient ______
    • Reason: ___________________________________________________
  2. (Serious): Patient ______
  3. (Stable): Patient ______
  4. (Least Critical): Patient ______

Round 6 :: The Typical School Day

You are the school nurse. The bell just rang for 3rd period.

  • Patient U: The “Shop Student.” Got a bad electrical shock. They are awake but their chest feels “fluttery” and tight.
    • Vitals: BP 100/60, Pulse 130 and Irregular.
  • Patient V: The “Mathlete.” Hunched over holding their lower right stomach. Pain is sharp; they just threw up.
    • Vitals: Temp 101.5°F, Pulse 105, BP 120/80.
  • Patient W: The “Choir Singer.” Locked their knees on the risers and passed out. Woke up 5 seconds later feeling normal.
    • Vitals: Pulse 75, BP 110/70.
  • Patient X: The “Artist.” Cut their thumb with an exacto knife. Bleeding stopped when they squeezed it in a paper towel.
    • Vitals: Pulse 80, BP 115/75.

YOUR RANKING:

  1. (Most Critical): Patient ______
    • Reason: ___________________________________________________
  2. (Serious): Patient ______
  3. (Stable): Patient ______
  4. (Least Critical): Patient ______

Answers below

 

TRIAGE CHALLENGE: ANSWER KEY

ROUND 1: THE CLINIC (Day Shift)

  • 1. Patient B (Most Critical): Altered Mental Status + Low BP. Confusion is always a red flag in diabetes. It means the brain is no longer getting the fuel it needs. The low blood pressure combined with high sugar suggests the body is severely dehydrated and entering “Shock.”
  • 2. Patient D (Serious): Airway & Oxygen. A pulse oximetry reading of 93% is below the healthy 95–100% range. Wheezing indicates her airways are narrowing. She is still awake and breathing, but if she tires out, her oxygen will drop further.
  • 3. Patient C (Stable): Nerve vs. Vitals. While losing a reflex and feeling in a leg is a major neurological issue (likely a slipped disc), it is not a life-threat. His heart and lungs are stable.
  • 4. Patient A (Least Critical): Normal Vitals. His “weird” stomach feeling is likely psychosomatic (anxiety-driven) because all his objective numbers (BP, Pulse, Pupils) are perfect.

 

ROUND 2: THE NIGHT SHIFT (Emergency Room)

  • 1. Patient G (Most Critical): Cushing’s Triad. This is the deadliest combo: High BP + Slow Pulse + Unequal Pupils. It signals “Brain Herniation”—the brain is being squeezed out of the skull. This is a neurosurgical emergency.
  • 2. Patient F (Serious): Heat Stroke. “Hot and Dry” skin means the patient has stopped sweating, which is the body’s last defense against overheating. A pulse of 130 shows the heart is working overtime to compensate for extreme dehydration.
  • 3. Patient H (Stable): A Crying Baby is a Breathing Baby. While a 101°F fever is high for a toddler, his 97% oxygen level shows his lungs are doing their job. He is miserable, but his vital organs are stable.
  • 4. Patient E (Least Critical): Circulation is Intact. The “Pink and Warm” toes are the key. Even though the ankle is badly swollen, blood is successfully reaching the extremity. This is a simple musculoskeletal injury.

 

ROUND 3: FRIDAY NIGHT FOOTBALL

  • 1. Patient J (Most Critical): Anaphylaxis. Swelling lips and a “raspy” voice mean the airway is physically closing. The low BP (88/50) means they are in “Anaphylactic Shock.” They need an EpiPen immediately to reopen the airway.
  • 2. Patient K (Serious): Compound Fracture. This looks the worst, but it isn’t the deadliest. Because the bone is through the skin, there is a high risk of infection and blood loss, but as long as the pulse is stable, they can wait behind an airway emergency.
  • 3. Patient I (Stable): Stimulant Overdose. A pulse of 140 is very high, but the patient is alert and the BP is holding. Their body just needs time to metabolize the caffeine.
  • 4. Patient L (Least Critical): The “Medical Trick.” 100% oxygen proves the patient is getting more than enough air. The numbness in the hands is caused by “blowing off” too much $CO_2$ from breathing too fast. Calm coaching will fix this, not medicine.

 

ROUND 4: THE AMUSEMENT PARK

  • 1. Patient M (Most Critical): Arterial Hemorrhage. “Bright red and spurting” means a high-pressure artery was hit. The low BP (90/50) means they have already lost a significant volume of blood. They can bleed out in under 3 minutes without a tourniquet.
  • 2. Patient N (Serious): Severe Hypoglycemia. A glucose of 45 is a “Critical Low.” Without sugar, the brain will begin to shut down, leading to seizures or a coma.
  • 3. Patient O (Stable): Minor Head Trauma. Because the pupils are “Equal and Reactive,” there is no evidence of major brain swelling yet. They need monitoring, but they are neurologically intact for now.
  • 4. Patient P (Least Critical): Environmental Discomfort. A first-degree burn (sunburn) and thirst are not emergencies. They need fluids and shade, but no medical intervention is required to save their life.

 

ROUND 5: THE WINTER SKI TRIP

  • 1. Patient Q (Most Critical): Severe Hypothermia. Once shivering stops, the body is no longer fighting. A pulse of 40 is dangerously slow (Bradycardia), indicating the heart is literally freezing and about to stop.
  • 2. Patient R (Serious): Neurovascular Status. While the shoulder is deformed, the “warm and pink” fingers prove the axillary artery is not pinched. The pain is 10/10, but the limb is currently getting blood.
  • 3. Patient S (Stable): Non-Threatening Pain. “Snow Blindness” is essentially a sunburn on the eyeballs. It is excruciating and causes temporary blindness, but it does not affect the heart, lungs, or brain.
  • 4. Patient T (Least Critical): Localized Burn. A single blister indicates a minor second-degree burn. It is a small surface area and does not pose a systemic threat to the patient.

 

ROUND 6: THE TYPICAL SCHOOL DAY

  • 1. Patient U (Most Critical): Cardiac Arrhythmia. Electrical shocks can “scramble” the heart’s electrical system. An irregular pulse of 130 means the heart is not pumping blood efficiently and could flip into a fatal rhythm (like V-Fib) at any moment.
  • 2. Patient V (Serious): Surgical Abdomen. Lower right pain + fever + vomiting is the classic presentation for Appendicitis. If the appendix ruptures, the patient will develop sepsis. They need surgery today, but they aren’t dying this second.
  • 3. Patient W (Stable): Fainting (Syncope). Standing with locked knees prevents blood from returning to the heart. Once the patient falls down, their head is level with their heart, blood flow returns, and they wake up. They are fine.
  • 4. Patient X (Least Critical): Controlled Bleeding. A minor cut that stops with simple pressure is never an emergency. Wash it and apply a bandage.
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