In the ED after a motor vehicle crash, which patient should the nurse assist first?

• A. Room 305 - patient with a possible ectopic pregnancy who reports intense shoulder pain
• B. Room 201 - patient with stable vital signs
• C. Room 210 - patient with mild headaches
• D. Room 402 - patient with minor lacerations

Answer: (A)

In this ED scenario, the first priority is any condition that could rapidly become life-threatening. A patient who is pregnant (or possibly pregnant) with a suspected ectopic pregnancy who reports intense shoulder pain signals intra-abdominal bleeding from a ruptured ectopic pregnancy. The shoulder pain is referred pain from diaphragmatic irritation due to free blood in the abdomen (a Kehr sign), a red flag for serious hemorrhage that can deteriorate quickly. Because this situation can escalate to hemorrhagic shock, it must be addressed immediately with rapid assessment and stabilization—establishing IV access, ordering bloodwork (including pregnancy test and crossmatch), imaging as indicated (ultrasound), and urgent obstetric consultation. The other patients have stable vital signs or minor injuries and do not present an immediate threat to life, so they are attended to after this emergent concern.