The first step in assessing an unresponsive and non-breathing patient is to ensure the airway is clear and open, followed by checking for breathing. If the patient is not breathing or only gasping, chest compressions should be started immediately. Checking the pulse can be done after assessing the airway and breathing. Administering oxygen should follow after ensuring a clear airway.
This patient's symptoms (chest pain, diaphoresis, nausea) and vital signs raise concern for a possible acute coronary syndrome (ACS), such as a myocardial infarction. The priority in his assessment is to monitor the heart rhythm with an ECG and assess for signs of ACS. Although pain management and blood glucose are important, addressing potential cardiac issues is the immediate priority.
Grunting and a decreased level of consciousness in a pediatric patient are concerning signs of impending respiratory failure. Grunting is an indication of respiratory distress and may suggest a compromised ability to oxygenate, while altered consciousness can signal hypoxia. Mild nasal flaring, tachypnea, and accessory muscle use are signs of distress but not as urgent as grunting with altered mental status.
For a trauma patient with signs of shock, the immediate priority is to establish large-bore IV access for fluid resuscitation to address hypovolemia and prevent further deterioration. While assessing the GCS and spinal injuries are important, the focus in trauma situations is on stabilizing circulation, which is best achieved through fluid resuscitation.
The patient’s symptoms of sudden, severe headache, nausea, photophobia, and elevated blood pressure are concerning for a potential subarachnoid hemorrhage (SAH). A CT scan is the most appropriate next step to assess for this life-threatening condition. Although migraines can present with similar symptoms, the severity and sudden onset require ruling out a hemorrhagic cause.
