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Ask Graph, Why is it so 
important in prioritization 

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questions? 
We were taught ABC's, airway, 

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breathing, circulation. 
But those are really confusing 

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for me. 
So when I look at a question and

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I use the method, reading the 
last part of the question first,

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I'm looking for these clue words
first. 

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Initial priority, urgent, most 
concerning, immediate report to 

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HCP. 
Do you see how quickly I knew 

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those 7 words? 
The minute I see one of those 

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words, I know it's a 
prioritization question because 

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I'm going to see these patients 
first. 

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Initial priority, urgent, most 
concerning, immediate report to 

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HCP. 
So I'm looking for something 

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that I'm freaking out about. 
But airway, breathing, 

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circulation didn't cut it for 
me. 

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So as I wrote questions, as I 
did questions, I started seeing 

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patterns develop and that's 
where Ask Graph came about. 

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So what does Asgraf mean? 
Well, the first A is airway. 

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You can't get around airway, 
Airways compromised. 

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We are seeing that patient 
first. 

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So what types of clues are we 
going to see when it comes to 

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airway? 
Look for certain terms like 

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strider, look for angioedema, 
asphyxiation, same facial hair. 

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How about overdose of things 
like opioids or insulin where 

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the respiratory rate drops to 
6:00 or 8:00? 

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Look at aspiration. 
These are just some of the clue 

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words that they may throw at you
screaming that this is airway 

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and if you see airway, you're 
choosing it. 

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The S is sepsis. 
Now from sepsis on whatever I 

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talk about, find me one of them.
And if you find more than one of

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them, ask yourself these two 
questions. 

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Who do I have less time with and
what more can I do? 

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So these two questions again, 
who do I have less time with and

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what more can I do, are going to
help you decide if you see more 

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than one of ASGRAF. 
Again, airway above all else but

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the s s sepsis. 
Now with sepsis, we may see a 

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triad where we have somebody 
who's febrile above 100.4 

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Fahrenheit. 
They may be tachycardic and 

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hypotensive, and it'd be great 
if the boards gave us that. 

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That'd be amazing, but they're 
not. 

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The boards are all about 
critical thinking and logical 

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deduction. 
What does that mean? 

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What if I gave you a patient who
was post op post procedure, had 

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purulent discharge at the 
incision site and was 

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tachycardia, heart rate of 127. 
Did I give you their blood 

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pressure? 
No. 

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Did I give you a fever? 
No. 

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So what does that mean? 
You have to logically deduce by 

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purely discharge and tachycardia
that this patient is in fact 

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septic. 
This is what the boards are 

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testing. 
It's your job to understand and 

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logically deduce and use your 
critical thinking that this is 

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the one that we're going to see 
first. 

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Initial priority, urgent, most 
concerning, immediate report to 

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HCP. 
The K stands for potassium, more

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specifically changes in 
potassium. 

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Notice I didn't say hypo or 
hyperkalemic, I said changes in 

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potassium, which means low 
potassium or high potassium can 

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cause the most deadliest 
dysrhythmia that we are freaking

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out about, ventricular 
fibrillation. 

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We talked about that extensively
in the EKG lecture, but 

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potassium predominantly controls
the ventricle, which means any 

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change in potassium can throw 
that ventricle into a 

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dysrhythmia. 
And the one that we're freaking 

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out about is ventricular 
fibrillation, how to identify 

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it, do the strip, how to treat 
it all in our EKG lecture. 

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So we've got airway sepsis, 
potassium that's ask graph 

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starts with glucose below 70. 
Now hypoglycemia is something 

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that we're freaking out about. 
Sugar runs our body, it runs 

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almost every metabolic pathway. 
So now if we don't have it, 

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maybe too much insulin, maybe 
their pump is not being 

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regulated properly, maybe 
they're trying to overdose, 

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suicidal ideation, a little bit 
of mental health there. 

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And now their blood glucose 
drops below 70, and they'll tell

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you specifically that this 
patient has a blood glucose of 

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56, of 62. 
We're freaking out about that. 

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They're going to shut down, 
they're going to become 

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comatose, and they're going to 
die. 

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The R in Asgraf is lethargy or 
grunting. 

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We use these two terms in 
pediatric patients. 

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How else you describe a child 
that is not responding? 

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They were lethargic. 
They're grunting these two words

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in a pediatric patient and not 
always in pediatric patients, 

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but usually you'll see these two
words to indicate that this 

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child is in grave danger. 
They're the ones we're freaking 

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out about. 
The A is altered mental status. 

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Look for these clue words, 
seizures, hallucinations, 

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delusions, delirium. 
All these words indicate that 

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this patient all of a sudden in 
the last hour acute has suddenly

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had a change in mental status 
and we're freaking out about it.

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But again, look at the latter 
part of what I just said. 

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All of a sudden in the last hour
acute. 

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Why did I give you time? 
Which leads me to another test 

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taking strategy. 
If you see time, age, gender, 

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anatomical location, you are 
paying attention to it like a 

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hawk. 
I gave it to you for a reason. 

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I said all of a sudden I said 
acute. 

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I said left lower extremity. 
I said 83 year old male. 

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I said it for a reason, a 17 
year old female. 

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Why did I give you those? 
I gave it to you for a reason. 

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So pay attention. 
So with altered mental status, 

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look at that last hour acute, 
all of a sudden what happened? 

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The P is peritonitis. 
So what is the peritoneum? 

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The peritoneum in cases the GI 
tract and when something is 

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wrong, inflammation, infection, 
hemorrhaging, it is going to 

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irritate the peritoneum. 
They're going to develop 

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peritonitis and look for the 
cool words guarding rigidity 

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board like abdomen. 
All these are indicating to you 

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that something in that GI tract 
in that peritoneum is wrong. 

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So we're going to see that 
patient first, initial priority,

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urgent, most concerning, 
immediate report to HCP. 

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The HNS graph is twofold. 
We've got the first H, which is 

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hemorrhaging. 
In hemorrhaging, we're going to 

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see a patient that's tachycardia
and hypotensive. 

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Again, it'd be great if they 
told us that, but how about 

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swelling at the incision site 
with a blood pressure of 80 / 

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60? 
Did I give you that they're 

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tachycardic? 
Did I tell you that they're 

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bleeding? 
No, it's your job to logically 

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deduce and use your critical 
thinking skills. 

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The last one is heart attack. 
So myocardial infarction. 

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Same thing. 
We talked about this extensively

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in our cardio lecture. 
With a heart attack. 

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Look for the signs and symptoms 
of a heart attack. 

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That diaphoresis, dizziness, 
chest pain radiating to the left

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arm, up the jaw. 
Look for the signs and symptoms 

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because this patient is having a
heart attack and we need to do 

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something right now. 
We don't have time. 

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All of these are your 
prioritization situations. 

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Are they going to be 100% of the
time? 

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No, absolutely not. 
But it's going to hold true 

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about 85 to 90% of the time. 
And if you're scoring 85 to 90% 

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on prioritization, it's going to
bring whatever else you have up,

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which is going to ultimately 
help you pass. 

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That's why our students are 
doing so well. 

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We're not looking for airway 
breathing circulation. 

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We're looking for one of ask 
wrap. 

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You combine that with the method
and now the entire test changes.

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Now you're not making mistakes. 
Now you're not second guessing 

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yourself using the method. 
So make sure you watch the 

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method, watch me utilize the 
method and start using it in 

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your day-to-day practice. 
The second part about 

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prioritization is I took it a 
step further. 

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When you see a patient that's 
post op, post procedure, you're 

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going to look for ASH of ASGRAF.
Think about it, if we're taking 

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a patient into a procedure or 
into an operation, we're 

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probably going to sedate them, 
maybe intubate them. 

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You think Airways is going to be
compromised? 

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Absolutely. 
Can they develop, alter mental 

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status, maybe a drug, drug 
interaction? 

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Absolutely. 
Sepsis, Well, are we doing 

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something invasive 100% and then
hemorrhaging, invasive heart 

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attack. 
Doctor Z, how does that work? 

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Don't we get cardiac clearance? 
Ever heard those terms before 

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cardiac clearance before we send
somebody in to do a procedure? 

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Absolutely, because we don't 
want to put stress on the heart.

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So more specifically, if you see
a patient post op post procedure

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in your question stem, now we're
looking for ash out of ash 

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graph. 
So pay attention to this 

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prioritization test taking 
strategies because you're not 

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going to get it anywhere else. 
These are the advantages that 

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you're going to get here at 
NCLEX. 

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I yield. 
So make sure you know it down 

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pat. 
And if you have any questions, 

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feel free to reach out to us. 
Take care.