Question

After the emergency department nurse has received a status report on the following patients with head injuries, which patient should the nurse assess first?

A. A 20-yr-old patient whose cranial x-ray shows a linear skull fracture.
B. A 30-yr-old patient who lost consciousness for 10 seconds after a fall.
C. A 40-yr-old patient who has an initial Glasgow Coma Scale score of 13.
D. A 50-yr-old patient whose right pupil is 10 mm and unresponsive to light.

Answer 1

The emergency department nurse should assess patient D with an unresponsive and dilated pupil first, as this indicates a potential life-threatening brain injury. Rapid neurological assessment in this context is critical to prioritize treatment and optimize patient outcomes.

Step-by-step explanation:

The emergency department nurse should assess patient D first, the 50-year-old patient whose right pupil is 10 mm and unresponsive to light. This sign is indicative of a possible uncal herniation, where the pressure inside the skull is shifting brain tissue, presenting an immediate threat to life. Immediate medical intervention is critical to reduce intracranial pressure and prevent further brain damage or death.

Patient C, with an initial Glasgow Coma Scale score of 13, should be assessed next since a score lower than 15 suggests a mild to moderate brain injury that needs to be monitored closely. Patient B, who lost consciousness for 10 seconds, should be seen following patient C, as even a brief loss of consciousness can be serious. Lastly, patient A with a linear skull fracture should be seen as they too require attention, but their condition is potentially less immediately life-threatening compared to the others.

A rapid assessment of neurological function is vital in an emergency situation because it helps to quickly identify the severity and extent of neurological damage, which is critical for immediate treatment and can greatly influence the patient's recovery.