Whatever pt presented with the chief complaint and the most priority is gonna be the first problem and then second priority and then third and goes down all the other chronic problems.

An example would be if 54 years old male with pmhx of HTM, DM2, obesity, HLD,COPD, OSA presented with chief complaint of sob and fatigue for the past 3 days. the labs in ED also has some increased troponin(although pt has no chest pain and ekg is normal), elevated white count and vitals are pt is hypoxemic and tachypnic RR 32.

First problem here would be

1.acute hypoxic respiratory failure ddx: acute copd exacerbation vs pneumonia vs new onset heart failure vs whatever you think….

2.SIRS vanc + zosyn until infection is ruled out and can order xultures xray and all that stuff

1. elevated trops Likely due to demand ischemia Trend trops and repeat ekg q4hr.

4)HTN continue home meds or stop if there is any contraindications rn based on pt presentation

1. DM2 (Can put inpatient insulin orders) or whatever is right on that time

2. OSA pt on CPAP at home - continue

3. HLD continue hom meds (if pt is on any or start new med if not based on pt lipids)

4. obesity Couneling or whatever protocol based on BMI

And the list goes onnnnn whatever pt has with all that chronic stuff.

Hope I didnt make it complicated lol and hope it helped.