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Difficulty: MediumTrauma and Burns

A 52-year-old woman is brought to the emergency department by emergency medical services after being involved in a head-on motor vehicle collision. She is confused, tachypneic, and has blood on her face from a scalp laceration. Her vital signs show a blood pressure of 90/50 mmHg, a heart rate of 118/min, and a respiratory rate of 26/min. According to the Advanced Trauma Life Support (ATLS) protocol, arrange the following initial management steps in the correct chronological order.

  1. 1Verify patency of the oropharynx while ensuring cervical spine stabilization.
  2. 2Assess bilateral breath sounds and evaluate chest wall excursion.
  3. 3Apply direct pressure to the scalp laceration and initiate intravenous fluid resuscitation.
  4. 4Determine the Glasgow Coma Scale score and assess pupillary light reflexes.
  5. 5Remove all clothing to inspect for hidden injuries and initiate warming measures.

Answer

The correct sequence follows the ATLS primary survey algorithm: Airway, Breathing, Circulation, Disability, and Exposure.
The Advanced Trauma Life Support (ATLS) protocol utilizes a strict chronological sequence (ABCDE) for the initial evaluation of trauma patients to ensure the most rapidly fatal conditions are identified and treated first. The sequence is: Airway (with cervical spine protection), Breathing (ventilation and oxygenation), Circulation (hemorrhage control and fluid resuscitation), Disability (neurologic evaluation), and Exposure (complete undressing with environmental control).

Step-by-Step Solution

1
Identify the clinical scenario as an acute trauma resuscitation requiring the ATLS primary survey algorithm.
The ATLS protocol dictates a standardized sequential approach to identify and treat the most immediate life-threatening injuries first.
Following a standardized algorithm prevents missing critical injuries in a chaotic trauma setting.
2
Prioritize Airway (A).
Verify patency of the oropharynx while ensuring cervical spine stabilization.
Without a patent airway, downstream interventions for oxygenation and perfusion are futile.
3
Prioritize Breathing (B).
Assess bilateral breath sounds and evaluate chest wall excursion.
Once the airway is secure, adequate oxygen exchange must be confirmed to treat conditions like pneumothorax or hemothorax.
4
Prioritize Circulation (C).
Apply direct pressure to the scalp laceration and initiate intravenous fluid resuscitation.
The patient is hypotensive and tachycardic, indicating shock; restoring perfusion comes immediately after securing airway and breathing.
5
Prioritize Disability (D) and Exposure (E).
Determine the Glasgow Coma Scale score, then remove all clothing.
Neurologic baseline must be established rapidly, followed by complete physical exposure to find hidden injuries while mitigating hypothermia.

Key Concept

Advanced Trauma Life Support (ATLS) Primary Survey
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Topics

Trauma and Burns

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