Examkin

Question

Difficulty: MediumTrauma and Burns

A 25-year-old male is brought to the emergency department after falling 20 feet from a roof. He is unconscious, hypotensive, and has obvious facial trauma. Arrange the following steps of his initial assessment and management in the correct chronological order according to Advanced Trauma Life Support (ATLS) protocols.

  1. 1Assess airway patency and secure the airway with manual in-line cervical spine stabilization.
  2. 2Evaluate chest wall motion, auscultate breath sounds, and apply supplemental oxygen.
  3. 3Assess peripheral pulses, control any compressible hemorrhage, and establish large-bore intravenous access.
  4. 4Determine the Glasgow Coma Scale score and evaluate bilateral pupillary responses.
  5. 5Completely undress the patient to inspect for hidden injuries while actively preventing hypothermia.

Answer

The correct chronological sequence for the ATLS primary survey is: Airway and cervical spine stabilization, Breathing and ventilation, Circulation and hemorrhage control, Disability (neurologic evaluation), and Exposure/environmental control.
The Advanced Trauma Life Support (ATLS) primary survey follows a strict chronological protocol designed to identify and treat the most rapidly fatal injuries first. The sequence is 'ABCDE': Airway maintenance with cervical spine restriction, Breathing and ventilation, Circulation with hemorrhage control, Disability (neurologic status), and Exposure/environmental control. Adhering to this order ensures that hypoxia and severe shock are reversed before focusing on focal neurologic deficits or hidden, less acute injuries.

Step-by-Step Solution

1
Prioritize the airway and cervical spine
Assess airway patency and secure the airway with manual in-line cervical spine stabilization.
Airway compromise is the most rapidly fatal complication in trauma. Cervical spine injury must be assumed in any high-energy blunt trauma.
2
Ensure adequate oxygenation and ventilation
Evaluate chest wall motion, auscultate breath sounds, and apply supplemental oxygen.
Once the airway is patent, oxygen delivery to the lungs must be confirmed to prevent hypoxia.
3
Assess and support hemodynamics
Assess peripheral pulses, control any compressible hemorrhage, and establish large-bore intravenous access.
Hemorrhagic shock is the most common cause of preventable death in trauma; it must be addressed immediately after oxygenation.
4
Perform a rapid neurologic evaluation
Determine the Glasgow Coma Scale score and evaluate bilateral pupillary responses.
A baseline neurologic status is needed to identify traumatic brain injury and signs of increased intracranial pressure.
5
Expose the patient fully
Completely undress the patient to inspect for hidden injuries while actively preventing hypothermia.
Full exposure is necessary to avoid missing hidden trauma, but hypothermia exacerbates trauma-induced coagulopathy and must be prevented.

Key Concept

Advanced Trauma Life Support (ATLS) Primary Survey Sequence
Rate this question

Topics

Trauma and Burns

More questions from this topic