Exception #1: Time Sequence
Looks Like: "After...", "Following...", "Has already...", "Next..."
Trap: Highest priority already completed
Example: "After establishing airway..."
✗ Check airway again
✓ Move to breathing
Handle:
  1. ID completed actions
  2. Start Stack where they left off
  3. Move to next in sequence
Exception #2: Exclusion
Looks Like: "EXCEPT...", "AVOID...", "NOT appropriate..."
Trap: Brain picks BEST, question wants WORST
Example: "All appropriate EXCEPT:"
✗ Pick best action
✓ Find harmful action
Handle:
  1. Circle EXCEPT in red
  2. Reverse thinking
  3. Find dangerous option
  4. Often highest Stack (too aggressive)
Exception #3: Chronic vs New
Looks Like: "Usual...", "Chronic...", "Sudden...", "New onset..."
Trap: Stack prioritizes chronic high over new low
Example: Chronic pain 8/10 + New confusion
✗ Treat pain (Stack #3)
✓ Assess confusion (new problem)
Handle:
  1. Flag chronic/usual
  2. Highlight new/sudden
  3. New beats chronic
  4. Acute jumps up a Stack
Exception #4: Context-Specific
Looks Like: Psych unit, Cultural, Legal/ethical, Pediatric
Trap: Context changes priority meaning
Psych: Suicidal + needs insulin
✗ Glucose first
✓ Suicide = Safety (Stack #2)
Legal: Refusing treatment
✗ Force treatment
✓ Respect autonomy
Handle:
  1. Check unit/context
  2. Reframe for setting
  3. Safety includes emotional/legal
  4. Protect life AND rights
SAFETY NET PROTOCOL
1. Re-Read for Qualifiers
After Except Not Independent First Most/Least
2. Check Assumptions
  • Assuming unstable?
  • Ignoring time sequence?
  • Missing context?
  • Special population?
3. Override Rules
New > Old (even if old higher)
Unexpected > Expected
Reversible > Irreversible
Legal/Ethics > Clinical (sometimes)
4. Trust Your Gut When:
  • Two equally right
  • Too easy/obvious
  • Experience says no
  • Incomplete scenario
Red Flag Phrases
Time:
After • Following • Has completed • Next priority
Exclusion:
Except • Avoid • Contraindicated • Not appropriate
Context:
Psych unit • Cultural • Legal • Pediatric
Stability:
Chronic • Baseline • Long-standing • Controlled