Lock It In
Priority Is Threat Plus Time
Priority setting is not a contest between diagnoses.
Priority setting is not a contest between diagnoses. It is a decision about which patient faces the most immediate risk of serious harm and which intervention can change that risk first. Begin with airway, breathing, and circulation. An obstructed airway can become cardiac arrest; inadequate breathing can cause hypoxaemia and fatigue; poor circulation can progress to shock and organ injury. These threats outrank routine care, even when another patient has a more complicated medical history. The usual sequence is: 1. Immediate physiological threat before comfort or routine care. 2. Acute change before a stable chronic problem. 3. Actual deterioration before a possible complication, unless the possible event is imminent and preventable. 4. Unexpected findings before expected recovery findings. 5. Systemic threats before isolated problems, because hypoxia, shock, and altered consciousness affect the whole patient. This is a framework, not a rigid ladder. Severe pain is not automatically low priority: sudden chest pain, pain with hypotension, or severe abdominal pain with guarding may signal a life-threatening process. Conversely, a patient requesting analgesia with stable vital signs may safely wait while a...