急診室護理長正在為四名因車禍同時抵達的病患進行檢傷分類。哪位病患需要最立即的醫療介入？
An emergency department charge nurse is triaging four clients who arrived simultaneously after a motor vehicle collision. Which client requires the most immediate medical intervention?
- AA client clutching their right upper abdomen and reporting sharp, severe pain upon palpation.一名緊抓右上腹部並報告觸診時有尖銳、劇烈疼痛的病患。
- BA client with an obvious compound fracture of the right humerus and a weak radial pulse.一名右肱骨明顯開放性骨折且橈骨脈搏微弱的病患。
- CA client with a 10-centimeter bleeding laceration on the forehead who is crying in pain.一名額頭有10公分出血撕裂傷且因疼痛而哭泣的病患。
- DA client who exhibits paradoxical chest wall movement and severe shortness of breath.✓ 正解一名呈現胸壁反常運動且嚴重呼吸困難的病患。
本題測驗急診創傷的優先順序判斷。根據 ABC (Airway, Breathing, Circulation) 原則，任何影響呼吸的狀況都是最優先的。選項 D 的病患出現「安靜呼吸時胸壁反向運動 (paradoxical chest wall movement)」，這是連枷胸 (Flail Chest) 的經典特徵，表示多根肋骨斷裂導致胸廓失去支撐，病患即將面臨嚴重的呼吸衰竭與缺氧死亡，需要立即氣管插管。選項 C 是外傷出血，加壓即可。選項 B 的開放性骨折與選項 A 的腹部創傷雖然危險，但呼吸道的立即致命性優於周邊循環與腹腔。
According to ABC (Airway, Breathing, Circulation) principles, conditions compromising respiration take priority over other injuries. Paradoxical chest wall movement indicates flail chest, which leads to rapid respiratory failure and requires immediate intervention to prevent hypoxia and death.
ABC 法則在所有創傷急救 (Trauma triage) 都是通用的第一法則，Flail chest 必排第一。