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Difficulty: EasyInitial Stabilization and Triage

A 32-year-old rock climber is brought to the emergency department by paramedics after an estimated 30-foot fall. He arrives immobilized on a backboard with a rigid cervical collar in place. He is agitated, tachycardic, and has an obvious deformity of his right femur. Arrange the following steps of his initial trauma resuscitation in the correct chronological order according to standard Advanced Trauma Life Support (ATLS) primary survey principles.

  1. 1Assess airway patency while maintaining cervical spine protection.
  2. 2Evaluate bilateral breath sounds and ensure adequate ventilation.
  3. 3Establish large-bore intravenous access and evaluate for circulatory shock.
  4. 4Determine the Glasgow Coma Scale score and check pupillary response.
  5. 5Completely undress the patient to identify hidden injuries while preventing hypothermia.

Answer

The correct sequence is: Airway assessment, followed by Breathing evaluation, Circulation management, Disability assessment, and finally Exposure.
The primary survey in trauma follows a strict chronological sequence to identify and treat conditions in order of immediate lethality: Airway with cervical spine protection, Breathing and ventilation, Circulation with hemorrhage control, Disability (neurologic status), and Exposure/environmental control.

Step-by-Step Solution

1
Identify the primary goal of initial trauma resuscitation.
The goal is to identify and treat life-threatening conditions in a systematic, prioritized manner based on immediate lethality.
Standardized protocols prevent distracting injuries from delaying care for immediately life-threatening airway or breathing compromise.
2
Apply the primary survey mnemonic to the provided steps.
The sequence follows A (Airway), B (Breathing), C (Circulation), D (Disability), and E (Exposure).
This algorithmic sequence is universally accepted for the initial stabilization of major trauma patients.
3
Map the specific clinical actions to the algorithmic sequence.
Airway patency (A) -> Breath sounds (B) -> Intravenous access (C) -> Glasgow Coma Scale (D) -> Undressing the patient (E).
Mapping the actions ensures the correct chronological order is established for patient safety.

Key Concept

Advanced Trauma Life Support (ATLS) Primary Survey Sequence (ABCDE)
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Topics

Initial Stabilization and Triage

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