A nurse is triaging victims of a multiple motor-vehicle crash. The nurse assesses a client trapped under a car who is apneic and has a weak pulse at 120/min. After repositioning his upper airway, the client remains apneic. Which of the following actions should the nurse take?

Choice a) is incorrect because vesicles on the skin are a sign of cutaneous anthrax, not inhalation anthrax. Cutaneous anthrax is caused by direct contact with anthrax spores through a break in the skin. It causes a painless, black, necrotic lesion on the affected area.

Choice b) is correct because respiratory failure is a sign of inhalation anthrax, which is the most deadly form of anthrax. Inhalation anthrax is caused by breathing in anthrax spores that enter the lungs and spread to the bloodstream. It causes severe breathing problems, chest pain, shock, and death.

Choice c) is incorrect because sloughing of skin is a sign of necrotizing fasciitis, not inhalation anthrax. Necrotizing fasciitis is a rare bacterial infection that destroys the soft tissue under the skin. It causes severe pain, swelling, redness, blisters, and gangrene.

Choice d) is incorrect because flu-like symptoms are not specific to inhalation anthrax. Flu-like symptoms can be caused by many other conditions, such as influenza, common cold, or COVID-19. Flu-like symptoms include fever, cough, sore throat, headache, and muscle aches.

The correct answer is: a. Place a black tag on the client’s upper body and attempt to help the next client in need.

Choice A: Place a black tag on the client’s upper body and attempt to help the next client in need.

In mass casualty incidents, the START (Simple Triage and Rapid Treatment) triage system is often used. According to this system, if a patient is apneic (not breathing) and does not resume breathing after repositioning the airway, they are considered deceased or non-salvageable and should be tagged with a black tag. This allows the nurse to focus on other victims who have a higher chance of survival.

Choice B: Start CPR

While starting CPR might seem appropriate in a normal setting, during a mass casualty incident, resources and time are limited. The priority is to save as many lives as possible. Performing CPR on an apneic patient with a weak pulse would take significant time and resources that could be used to help other victims with a higher chance of survival.

Choice C: Place a red tag on the client’s upper body and obtain immediate help from other personnel.

A red tag is used for patients who need immediate care and have a high chance of survival if treated promptly. Since the client remains apneic even after repositioning the airway, they do not meet the criteria for a red tag.

Choice D: Reposition the client’s upper airway a second time before assessing his respirations.

Repositioning the airway a second time is not recommended in the START triage system. If the patient does not resume breathing after the initial repositioning, they are considered non-salvageable.