A 32-year-old male construction worker is brought to the trauma bay after falling approximately 20 feet from scaffolding. He is moaning incomprehensibly and has blood pooling in his oropharynx with prominent gurgling sounds on inspiration. His blood pressure is 85/50 mm Hg and heart rate is 135/min. Arrange the following initial evaluation and stabilization steps in the correct chronological sequence according to standard trauma life support principles.
- 1Clear the oropharynx with rigid suctioning while maintaining cervical spine immobilization
- 2Perform endotracheal intubation to secure the airway
- 3Establish bilateral large-bore peripheral intravenous access and initiate crystalloid resuscitation
- 4Perform a focused assessment with sonography for trauma (FAST) to identify potential sources of hemorrhage
Answer
The correct chronological sequence adheres strictly to the ABCs of trauma: clear the airway with suctioning first, secure it with endotracheal intubation, address circulation with intravenous access and fluids, and finally perform the diagnostic FAST exam.
The correct chronological sequence adheres strictly to the primary survey of advanced trauma life support, commonly summarized as the ABCs (Airway, Breathing, Circulation). For this patient, the immediate threat to life is airway compromise. Therefore, clearing the airway with suctioning while maintaining cervical spine precautions is the absolute first step. Once cleared, a definitive airway is established because the patient is obtunded. After securing Airway and Breathing, the focus shifts to Circulation; placing large-bore intravenous lines and giving fluids addresses his hemorrhagic shock. Finally, adjuncts like the FAST exam are utilized to find the source of bleeding only after the ABCs are stabilized.
Step-by-Step Solution
Key Concept
Advanced Trauma Life Support (ATLS) Primary Survey Sequence