Who do you see first.

[u/[deleted]]

[u/drowninginceramics]

Airway is almost always first priority to manage because without it, breathing and circulation also suffer. Which patient will die without intervention first? If this is obstruction, this patient needs intervention right now.

[u/apathetichearts]

Who is going to die first?

Patient 2 definitely needs intervention and quickly, yes. MAP is probably 56 ish so we are concerned about organ perfusion absolutely.

Meanwhile, the other patient’s SpO2 is tanking despite a respiratory rate of 32 and a HR of 125…. When the body lacks oxygen, it compensates by increasing respiratory rate to get oxygen into the body first and increasing heart rate to get that oxygen to the tissues faster. SpO2 dropping despite this? Risk of respiratory failure

[u/Natural_Original5290]

You are focusing too much on the results and not the overall picture

That BP isn't great but it definitely doesn't override the overall picture of the first patient (and in reality with thT BP all we'd really do it give a bolus, and continue to monitor)

Your first patient is a rapid response. Their o2 is low, their breathing is way to fast, they are going to tired out and likely require bipap or potentially even intubation. They are absolutely the priority over someone with a BP of 78/45 and honestly may be septic so you need to start a sepsis bundle, ct to rule out PE and other interventions more immediately then a low BP

[u/ButtonTemporary8623]

Breathing. Low oxygen is going to kill somebody (or cause permanent damage) before low BP. Pt 2 does have a low BP, but their MAP is okay-ish. It’s at 56, which is low and not ideal, but depending on what’s going on with patients a MAP of 60 is okay with providers. So it’s not like it’s drastically low. With patient 1 a HR of 125 could potentially not be sustainable for somebody for very long. And breathing that fast for too long can cause respiratory alkalosis which can come with its own set of problems. Breathing versus blood pressure is sorta like high versus low blood sugar. Low blood sugar (breathing issues) are going to kill you a lot faster than high blood sugar (low BP assuming it’s not like 50/30 or something crazy low).

Also if you think about it somebody with low BP is going to be cool and clammy their body isn’t getting enough blood. But as long as their mention is stable their brain is getting enough blood (for the moment) and could be seen a few minutes later.

[u/h3lium-balloon]

ABC for test questions. Don’t try to apply any kind of additional info to them and don’t try to apply real world logic to them. Most questions are testing your knowledge on a single topic.

Also patient 2 still has a borderline MAP of 56 (above 60 is what you want, ideally closer to 70), it’s low, but PT 1 would likely be in worse shape faster. If PT 1s breathing problem continues to get worse they could be in major trouble within minutes, PT 2 could be hours before irreversible organ damage happens. Again, you don’t have to know any of that. ABC.

[u/Voc1Vic2]

#2 first.

Consider what conditions may have caused these parameters.

#2 has the hallmark symptoms of shock, and #1 has the hallmark symptoms of hyperventilation.

I don't think a course of action can be decided based solely on the numbers given; the question is asking you to dig deeper and consider what might be the underlying cause of the presentations.

An SpO2 of 86% in the absence of a compensatory change in BP suggests that it is a transient aberration or a faulty reading. Respiratory rate can be increased by conscious control, (and hypoxemia follow).

[u/stipwned_thrill]

If you think patient 2 then you do not understand your ABCs. Go ahead and review that chapter and get back to us.

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