急診檢傷護理師觀察到一位68歲男性緊抓著他的右眼並痛苦地呻吟。他平常身體健康，表示剛才正在看書時視力突然變得極度模糊，隨後伴隨劇烈的眼睛痛、嚴重的頭痛與嘔吐。他的血壓為 190/105 mmHg。護理師應優先將哪位病患檢傷為第一順位？
An ER triage nurse observes a 68-year-old male clutching his right eye while moaning in severe pain. Usually healthy, he states he was reading when his vision suddenly became extremely blurry, followed by agonizing eye pain, a severe headache, and vomiting. His BP is 190/105 mmHg. Which client should the nurse triage first?
- AA 45-year-old female post-laparoscopic cholecystectomy reporting right shoulder pain.一位45歲女性，腹腔鏡膽囊切除術後主訴右肩疼痛。
- BA 24-year-old male with sickle cell disease rating his joint pain as 10/10 and requesting IV opioids.一位24歲男性，患有鐮狀細胞疾病，關節疼痛評分為10/10，要求靜脈注射鴉片類止痛藥。
- CA 70-year-old female with atrial fibrillation whose current apical heart rate is 110 bpm.一位70歲女性，患有心房顫動，目前心尖心率為110次/分。
- DA 68-year-old male with sudden, agonizing eye pain, severe headache, and vomiting reporting blurred vision.✓ 正解一位68歲男性，主訴突發劇烈眼痛、嚴重頭痛和嘔吐，並報告視力模糊。
本題測驗急診檢傷優先排序 (Triage Prioritization)。檢傷判斷的核心在於找出「危及生命、肢體或器官 (Life, limb, or organ threatening)」的急性發作。選項 D 的 68 歲男性出現了突發性劇烈眼痛、視力模糊、嚴重頭痛、嘔吐及高血壓，這是急性閉角型青光眼 (Acute angle-closure glaucoma) 的絕對經典且極度危險的臨床表現。如果不在數小時內立刻降壓，這會導致視神經被永久性摧毀，造成不可逆的失明（器官威脅）。選項 B 是鐮狀細胞貧血危機引起的劇痛，雖然病患極度痛苦，但除非出現急性胸腔綜合症或器官缺血，否則關節痛不會立即致死。選項 A 是腹腔鏡後的無害性反射痛（腹腔打入二氧化碳會刺激橫膈膜，痛覺放射至右肩），屬於預期內的正常現象。選項 C 房顫心跳 110 次/分雖需控制，但並未達到致命性血流動力學不穩的急救標準。
This client exhibits classic signs of acute angle-closure glaucoma, including sudden agonizing eye pain, blurred vision, severe headache, and vomiting, which threaten permanent organ damage if not treated immediately. Other options represent less urgent conditions: referred shoulder pain is expected after laparoscopy, sickle cell pain is managed but not typically life-threatening without other complications, and controlled atrial fibrillation is stable.
世界級急診檢傷共識。急性青光眼發作屬於「Opthalmic Emergency 眼科急症」，若延誤會直接失明，必須在 1 級或 2 級檢傷立刻收治。