Editing Management of Care (section)

== Establishing Priorities ==

Prioritization determines which patient is seen first and which problem is addressed first. Several frameworks are applied in sequence; they rarely conflict, and when they do, the physiologic frameworks win.

=== Airway, breathing, circulation ===
'''ABC''' is the first filter. An airway problem outranks a breathing problem, which outranks a circulation problem, which outranks everything else. Signs pointing to airway compromise, such as stridor, drooling, gurgling, a swelling tongue, or the inability to speak, take absolute precedence.

'''An important qualifier.''' Cardiopulmonary resuscitation for a pulseless patient uses '''C-A-B''' (compressions first), because the emergency is circulatory arrest, not obstruction. ABC is the framework for prioritizing among patients; CAB is the sequence within a cardiac arrest.

=== Maslow's hierarchy of needs ===
When no patient has an ABC problem, physiologic needs (oxygen, fluid, nutrition, elimination, pain, rest) outrank safety and security needs, which outrank love and belonging, which outrank esteem, which outrank self-actualization. This framework separates a physical need from a psychosocial one. The practical caution is that Maslow is applied '''after''' ABC and safety, not instead of them, and a psychosocial answer can still be correct when every option is psychosocial or when the physiologic issue has already been addressed.

=== Acute versus chronic, unstable versus stable ===
An '''acute''' problem outranks a '''chronic''' one. An '''unstable''' patient outranks a stable one. A '''sudden, unexpected''' change outranks a gradual, expected one. A patient whose findings are '''inconsistent with the diagnosis''' outranks a patient whose findings are exactly what the diagnosis predicts. A patient with chronic 8-out-of-10 arthritis pain waits behind the postoperative patient whose pain suddenly changed in character.

=== Actual versus potential, and risk of harm ===
An '''actual''' problem outranks a '''risk''' or potential problem. Among risks, the one with the highest probability of serious, irreversible harm comes first.

=== The nursing process as a priority framework ===
Assessment precedes intervention. When the options include both assessing and acting, assess first, '''unless''' the situation is an immediate life threat with an obvious remedy. If a ventilator alarms and the patient is cyanotic, do not gather more data; disconnect and manually ventilate. If a patient reports dizziness, assess before acting.

=== Safety and the least restrictive intervention ===
Physical safety concerns, including fall risk, wrong-patient errors, and infection transmission, are prioritized above comfort and psychosocial needs. When several safety interventions would work, choose the '''least restrictive''' one that is effective.

=== Triage frameworks ===
In an emergency department, patients are sorted by acuity so that the sickest are seen first. In a '''mass casualty or disaster''', the goal changes from doing the most for each individual to doing the '''greatest good for the greatest number'''. Under a color-coded disaster system, red or immediate marks life-threatening injuries that are survivable with rapid intervention; yellow or delayed marks serious injuries that can tolerate a short wait; green or minimal marks the walking wounded; and black or expectant marks injuries incompatible with survival given available resources. Recognizing this reversal is the point of most disaster items: in daily practice the most critically injured are treated first, and in a disaster the patient who cannot be saved with the resources at hand is not treated first.

'''Application note.''' A practical sequence for any "which patient do you see first" item is: eliminate any option that is an expected finding for that diagnosis, then apply ABC, then unstable over stable, then acute over chronic, then actual over potential. If two options remain, ask which patient will deteriorate soonest without you.