A -year-old man is brought to the trauma bay via ambulance after being ejected from a vehicle during a high-speed rollover collision. On arrival, he is unresponsive. Vital signs show a blood pressure of mm Hg, a heart rate of /min, and a respiratory rate of /min with shallow, gurgling respirations. Paramedics report a large, deep laceration on his left mid-thigh that is actively spurting bright red blood. According to standard trauma resuscitation protocols, arrange the following initial management steps in the correct chronological order.
- 1Apply direct manual pressure and a tourniquet to the left thigh
- 2Perform endotracheal intubation while maintaining in-line cervical spine stabilization
- 3Auscultate bilateral breath sounds and assess adequacy of ventilation
- 4Establish bilateral large-bore intravenous access and initiate warmed crystalloid infusion
- 5Perform a rapid neurologic evaluation and calculate the Glasgow Coma Scale score
Answer
The correct sequence follows the ATLS <C>ABCDE protocol: 1) Hemorrhage control, 2) Airway, 3) Breathing, 4) Circulation, 5) Disability.
The correct order strictly follows the ATLS 10th edition primary survey algorithm, <C>ABCDE. Catastrophic, exsanguinating hemorrhage (<C>) must be controlled immediately with direct pressure or a tourniquet because it leads to death faster than airway loss. Once massive external bleeding is halted, the trauma team proceeds to secure the compromised airway (A) with intubation, assess breathing and ventilation (B), establish IV access for fluid resuscitation to manage hemorrhagic shock in circulation (C), and finally assess disability (D) with a rapid neurologic examination.
Step-by-Step Solution
Key Concept
The ATLS primary survey emphasizes the <C>ABCDE approach, prioritizing the control of catastrophic (exsanguinating) hemorrhage before airway management.