Triage Challenges

Round 1 :: Day Shift

nstructions: 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 HIGH (>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 ______

(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 (Very Fast), 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 (High), Pulse 50 (Slow), 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 (Fever), BP 115/75, Oxygen (SpO_2) 97%.

YOUR RANKING:

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

(Least Critical): Patient ______

Round 3 :: The Big Game

Instructions: You are the medic on the sidelines of the Homecoming Football 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 (Very Fast), BP 130/85, Alert but jittery.

  • Patient J: The “Band Kid.” Ate a cookie from the bake sale and didn’t know it had peanuts. Lips are swelling, voice sounds raspy/hoarse.

    • Vitals: Pulse 110, BP 88/50 (Low), Wheezing loudly.

  • Patient K: The “Cheerleader.” Tried a backflip and landed wrong. Left arm is bent in a “Z” shape and you can see white bone poking through the skin. Screaming in pain.

    • Vitals: Pulse 110 (from pain), BP 120/80, Color is pale.

  • Patient L: The “Superstar Quarterback.” Just saw his ex-girlfriend with someone else. Breathing very fast (hyperventilating) and says “I can’t feel my hands!”

    • Vitals: Pulse 90, Oxygen ($SpO_2$) 100%, Respiratory Rate 40 breaths/min.

YOUR RANKING:

  1. (Most Critical): Patient ______

    • Reason: ___________________________________________________

  2. (Serious): Patient ______

  3. (Stable): Patient ______

  4. (Least Critical): Patient ______

 

TRIAGE CHALLENGE: ANSWER KEY

ROUND 1 :: The Clinic

1. MOST CRITICAL (Red Tag): Patient B (The Grandma)

  • The Clues: Confusion + High Glucose (>400) + Low BP (90/60).

  • The Diagnosis: Diabetic Ketoacidosis (DKA) or Shock.

  • The Why: The confusion implies her brain is affected. The low blood pressure implies her organs aren’t getting enough blood. This is life-threatening immediately.

2. SERIOUS (Yellow Tag): Patient D (The Soccer Player)

  • The Clues: Wheezing + Low Oxygen (93%).

  • The Diagnosis: Acute Asthma Attack.

  • The Why: “Airway is King.” They are awake, but their oxygen is low. They need medication now to open their lungs before they get tired and stop breathing.

3. STABLE (Green Tag): Patient C (The Weightlifter)

  • The Clues: Numb leg + Absent reflex + Normal Vitals.

  • The Diagnosis: Slipped Disc / Sciatica.

  • The Why: Painful and scary (can’t feel leg), but their heart and lungs are fine. They need an MRI, not CPR. They can wait.

4. LEAST CRITICAL (Green Tag): Patient A (The Nervous Student)

  • The Clues: Pacing + Normal Vitals.

  • The Diagnosis: Anxiety / Healthy.

  • The Why: All numbers are perfect. They are likely just nervous about their test.

ROUND 2 :: The ER (Night Shift)

1. MOST CRITICAL (Red Tag): Patient G (The Handyman)

  • The Clues: Head hit + Unequal Pupils + High BP / Low Pulse.

  • The Diagnosis: Brain Bleed / Herniation (Cushing’s Triad).

  • The Why: The unequal pupils combined with that specific BP/Pulse pattern is the classic sign of the brain swelling and crushing the brainstem. They need surgery immediately.

2. SERIOUS (Yellow Tag): Patient F (The Concert Fan)

  • The Clues: Fainted + Hot/Dry Skin + Fast Pulse (130).

  • The Diagnosis: Heat Stroke.

  • The Why: “Hot and Dry” means they have stopped sweating—their cooling system failed. They are dehydrated (Fast Pulse) and their BP is dropping. They need rapid cooling.

3. STABLE (Green Tag): Patient H (The Toddler)

  • The Clues: Fever + Crying Loudly + Good Oxygen (97%).

  • The Diagnosis: Flu or Viral Infection.

  • The Why: A crying baby is a breathing baby! The fever is high, but the oxygen is good. They are sick, but stable.

4. LEAST CRITICAL (Green Tag): Patient E (The Dancer)

  • The Clues: Swollen ankle + Toes Pink & Warm.

  • The Diagnosis: Sprained Ankle.

  • The Why: The “Pink & Warm” toes prove that blood is still flowing to the foot. It’s just a sprain. Ice it and wait.

 

Round 3 :: The Big Game

1. MOST CRITICAL (Red Tag): Patient J (The Band Kid)

  • The Diagnosis: Anaphylactic Shock.

  • The Why: Airway is King. A “raspy voice” and “swelling lips” mean their throat is closing shut. If you don’t give them an EpiPen in the next 2 minutes, they will stop breathing. The low BP (88/50) shows their body is already shutting down (shock).

2. SERIOUS (Yellow Tag): Patient K (The Cheerleader)

  • The Diagnosis: Compound (Open) Fracture.

  • The Why: This looks the scariest because of the bone and the screaming. It is serious (needs surgery and antibiotics to prevent bone infection), but because their BP is normal and they are screaming (airway is open!), they won’t die in the next 10 minutes.

3. STABLE (Green Tag): Patient I (The Super Fan)

  • The Diagnosis: Caffeine Overdose / Palpitations.

  • The Why: A pulse of 140 is fast, but they are alert and their BP is stable. They are miserable and might vomit, but they just need time for the caffeine to wear off. They are safe to wait.

4. LEAST CRITICAL (Green Tag): Patient L (The Quarterback)

  • The Diagnosis: Panic Attack / Hyperventilation.

  • The Why: This is a classic “medical trick.” They feel like they can’t breathe, but their Oxygen is 100% (perfect). The numbness in the hands is from breathing too fast (blowing off too much $CO_2$). They need a paper bag and a calm voice, not a doctor.

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