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Difficulty: EasyTrauma and Burns

A 25-year-old man is brought to the emergency department after a high-speed motor vehicle collision. He is unresponsive and has sustained multiple injuries. According to the Advanced Trauma Life Support (ATLS) protocol, arrange the following initial management steps of the primary survey in the correct chronological order.

  1. 1Establish a patent airway while maintaining cervical spine immobilization
  2. 2Assess bilateral breath sounds and ensure adequate ventilation
  3. 3Establish intravenous access and assess for signs of shock
  4. 4Determine the Glasgow Coma Scale (GCS) score and assess pupillary response
  5. 5Completely undress the patient to identify all injuries while preventing hypothermia

Answer

The correct sequence is: Airway and C-spine control, Breathing and ventilation, Circulation and hemorrhage control, Disability (neurologic exam), and Exposure/environmental control.
The Advanced Trauma Life Support (ATLS) protocol utilizes the ABCDE algorithm for the primary survey to systematically identify and treat the most immediately life-threatening conditions. The mandatory chronological order is: Airway maintenance with cervical spine protection, Breathing and ventilation, Circulation with hemorrhage control, Disability (rapid neurologic evaluation), and Exposure/environmental control.

Step-by-Step Solution

1
Identify the standard protocol for initial trauma assessment.
The scenario requires the ATLS primary survey approach.
ATLS provides a structured algorithm to identify and treat the most immediately life-threatening injuries first.
2
Apply the ABCDE mnemonic to the given clinical actions.
A = Airway, B = Breathing, C = Circulation, D = Disability, E = Exposure.
This mnemonic dictates the strict chronological order of the primary survey.
3
Arrange the steps according to the ABCDE sequence.
The airway must be secured first, followed by ventilation, then circulation/shock assessment, then neurologic status, and finally complete exposure.
Failure to follow this order can lead to preventable mortality, as an unprotected airway will quickly result in fatal hypoxia regardless of other interventions.

Key Concept

ATLS Primary Survey (ABCDE Algorithm)
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Topics

Trauma and Burns

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