Priority is a sort, not a fact
A vertical stack of three sieve plates labeled airway-breathing-circulation, unexpected, and rate of change; six patient tokens enter at the top, each plate holds one back, and three tokens fall through into a tray labeled CAN WAIT.
PRIORITY IS A SORT
A priority item does not ask what you know. It asks you to put four patients in an order and then name the one at the top. That is a different cognitive act from recall, and it fails for a different reason. You do not miss these items because a fact is missing. You miss them because you ranked once, quickly, by impression, instead of sorting three times, deliberately, by rule.
Panel 1 · The three passes
- Pass one. Who is losing airway, breathing, or circulation right now. Not who might. Not who has the diagnosis that usually does. Who is doing it in this sentence.
- Pass two. Whose finding is unexpected for their diagnosis, their procedure, and their day of stay. A finding that does not belong to the story has no plan attached to it yet.
- Pass three. Whose problem gets worse fastest if nobody walks in. This is the tie-break of last resort and it decides more items than candidates expect.
Run all three passes even when pass one produces a survivor, because pass one occasionally produces two.
Panel 2 · What the stem is really asking
- See first and assess first both mean go to the bedside and look. Your answer is a patient.
- Intervene first means the assessment has already happened inside the stem. Your answer is an action, and choosing to assess again is usually the wrong answer.
- Which patient should be assigned to means the work is staying inside somebody's existing role. Your answer is a match.
- Delegate is the only verb of the four that moves work to another person, and it is the only one where the receiver's role and competence matter.
Panel 3 · The sort fails when
You sorted by how sick the diagnosis sounds rather than by what the patient is doing now. A cirrhosis admission with a stable blood pressure and a documented plan loses to a patient one day after appendectomy who cannot take a deep breath, because cirrhosis is a condition and the shallow breathing is an event.
Memory hook: THREE PASSES — Body failing, Story wrong, Clock running.
Margin notethey never ask who is sickest. They ask who is changing.
Takeawaysort three times, do not rank once.
→ BOOK 02 · P5 for how cues are recognized before the sort begins.