Which patient is a priority when assessing vital signs?

The priority in this scenario is the 4-year-old with a closed head injury and a heart rate of 60. In pediatric patients, a low heart rate (bradycardia) can be concerning, especially in the context of a head injury. This situation raises the possibility of increased intracranial pressure or other complications, which can lead to serious outcomes if not addressed promptly.

In children, normals for resting heart rates vary, but a heart rate of 60 is significantly below typical values for a 4-year-old, indicating a potential emergency. The presence of a head injury adds to the urgency of this situation, as any alterations in vital signs can indicate deteriorating neurological status.

While the other patients may have needs for assessment, such as the 2-year-old with a high fever and the 6-year-old with a broken arm, their conditions do not present the same immediate risk associated with altered vital signs and a potential severe neurological compromise. The infant with a runny nose, although requiring assessment, does not have any immediate life-threatening conditions that would take priority over the child with the closed head injury. Therefore, the 4-year-old requires the most urgent attention in this context.