The triage nurse is assessing in the emergency department. Which client should be assessed first?

• A. The 10-year-old child who has a compound fracture of the right arm.
• B. The 17-year-old adolescent who has a pencil sticking out of his eye.
• C. The 38-year-old female who accidentally spilled hot grease on her leg.
• D. The 55-year-old man with hypertension who has an occipital headache.

Answer: (B)

In emergency triage, you prioritize conditions that could rapidly threaten life or a critical function. An eye penetrating injury with a pencil is the most urgent because a globe injury can lead to rapid and irreversible vision loss, infection, or other serious ocular damage if not addressed immediately by ophthalmology. Even if the patient seems stable, this type of injury has a high potential for sudden deterioration and requires urgent evaluation and protection of the eye.

The compound arm fracture, while serious, does not immediately threaten vital functions and can be managed after the most urgent eye injury. A burn from hot grease on the leg is painful and needs treatment, but unless it’s extensive, it’s not typically an immediate life threat. A hypertensive patient with an occipital headache may require assessment for possible hypertensive emergency, but without signs of end-organ damage or instability, it ranks lower in urgency than an ocular penetrating trauma.