The emergency room nurse is assigned the following clients at the beginning of their shift. Which client does the nurse see first?

Choice A reason: IV corticosteroids reduce inflammation in conditions like autoimmune pancreatitis, but they do not address acute hypoxemia. Sudden dyspnea and low oxygen saturation (85%) in acute pancreatitis suggest complications like ARDS or pleural effusion, requiring immediate oxygenation. Corticosteroids act slowly and are not the priority for correcting life-threatening hypoxia in this scenario.

Choice B reason: Sudden dyspnea and oxygen saturation of 85% indicate acute hypoxemia, potentially from ARDS or pulmonary complications in pancreatitis. High-flow oxygen therapy increases alveolar oxygen, improving arterial PaO2 and preventing tissue hypoxia. The ABCDE approach prioritizes breathing, making this the first intervention to stabilize the client before addressing underlying causes.

Choice C reason: ERCP diagnoses or treats pancreatic duct obstructions, a potential cause of pancreatitis, but it does not address immediate hypoxemia. Dyspnea and low saturation require urgent oxygen delivery to prevent organ damage. ERCP is a diagnostic or therapeutic procedure, not an acute intervention for respiratory distress in this critical scenario.

Choice D reason: Increasing IV fluid rate supports hydration and perfusion in pancreatitis, preventing hypovolemia. However, it does not correct acute hypoxemia causing dyspnea and low saturation. The ABCDE approach prioritizes breathing, and high-flow oxygen is needed to address the immediate threat of hypoxia, making fluid adjustment a secondary intervention.

Choice A reason: Thick secretions blocking airways are characteristic of conditions like chronic obstructive pulmonary disease or pneumonia, not pulmonary embolism. In pulmonary embolism, a clot obstructs pulmonary arteries, reducing blood flow to alveoli, not airflow. This leads to ventilation-perfusion mismatch, causing hypoxemia despite adequate breathing, making this explanation incorrect.

Choice B reason: A pulmonary embolism blocks pulmonary arteries, reducing blood flow to certain lung regions despite normal ventilation. This creates a ventilation-perfusion mismatch, where alveoli are ventilated but not perfused, leading to hypoxemia and respiratory distress. This is the primary mechanism of pulmonary embolism, making it the correct explanation for the family.

Choice C reason: This option suggests adequate blood flow but inadequate air to alveoli, which describes conditions like airway obstruction or atelectasis, not pulmonary embolism. In pulmonary embolism, the issue is reduced blood flow due to arterial obstruction, not insufficient air reaching alveoli, as breathing remains adequate, making this incorrect.

Choice D reason: Thickened alveolar-capillary membranes, impairing oxygen diffusion, occur in conditions like pulmonary fibrosis or edema, not pulmonary embolism. In pulmonary embolism, the primary issue is vascular obstruction, not membrane thickness, leading to reduced perfusion and hypoxemia despite normal alveolar structure, rendering this explanation scientifically inaccurate.