Questions

• You are working in an emergency department (ED) that, like all others, is challenged by a high number of attendances and boarded patients awaiting admission. There is one remaining cubicle space in majors, one in the resuscitation area, a single empty chair in minors, and a full waiting room. Four ambulances are queueing outside your doors, which you take handover for.

The patients are:

1. A 75-year-old who fell at home and has left hip pain. She was able to bear weight afterwards and is sitting in a wheelchair. Her observations are: Heart rate 105, blood pressure 135/75, respiratory rate 16, oxygen saturations 98% on air, temperature 36.8°C, pain 6/10.

2. A 45-year-old man with vomiting and diarrhoea over the past 36 hours. He has normal vital signs. His observations are: Heart rate 98, blood pressure 125/82, respiratory rate 18, oxygen saturations 97% on air, temperature 37.1°C, pain 1/10.

3. A 32-year-old man with splash burns from a deep fat fryer to his face and forearms. Cooling gel had been applied to the affected areas in his workplace. His observations are: Heart rate 92, blood pressure 128/78, respiratory rate 20, oxygen saturations 99% on air, temperature 37.3°C, pain 7/10.

4. A 78-year-old man who has colicky right flank pain for the last 6 hours. His observations are: Heart rate 85, blood pressure 95/62, respiratory rate 16, oxygen saturations 98% on air, temperature 37.2°C, pain 5/10.

Who do you prioritise for your remaining resuscitation bed?