— 照護管理 · EASY · MCQ —
護理師在急診進行檢傷分類，下列哪位病人應優先評估？
A nurse is performing triage in an emergency department. Which client should the nurse assess first?
- AA client with type 1 diabetes reporting intermittent diaphoresis and confusion✓ 正解一位第一型糖尿病病人主訴間歇性盜汗與意識混亂
- BA client with a superficial laceration on the forearm requiring sutures一位前臂有表淺割傷需縫合的病人
- CA client with a closed fracture of the radius reporting 6/10 pain一位橈骨閉鎖性骨折主訴疼痛程度 6/10 的病人
- DA client with a history of hypertension complaining of a mild headache一位有高血壓病史主訴輕微頭痛的患者
— Explanation · 中文詳解 —
急診檢傷分類（Triage）必須依據 ABC（呼吸道、呼吸、循環）原則。第一型糖尿病病人出現發汗（Diaphoresis）與意識混亂（Confusion）是嚴重低血糖（Hypoglycemia）的典型徵兆。若不及時處理，低血糖將迅速惡化導致昏迷、癲癇或腦損傷，屬於立即威脅生命的緊急狀況，必須優先介入。
Emergency triage must be based on the ABC (Airway, Breathing, Circulation) principle. A patient with type 1 diabetes who exhibits diaphoresis and confusion is presenting classic signs of severe hypoglycemia. If untreated, hypoglycemia rapidly deteriorates into coma, seizures, or brain injury, and constitutes an immediately life-threatening emergency requiring priority intervention.