A 40-year-old unconscious patient is brought to the casualty following a road traffic crash. His blood pressure was 80/60 mm of Hg. What will you do first?

1. A

   Patent airway

2. B

   Start ADH

3. C

   CT scan Head

4. D

   Infuse 2 liters of crystalloids

Appeared in: AIIMS Rishikesh & Jodhpur NO - 2017

Explanation

• The universally accepted standard for initial trauma assessment is the Advanced Trauma Life Support (ATLS) protocol, which follows the ABCDE sequence.
• The first step, 'A' for Airway, is the highest priority because an obstructed airway leads to hypoxia and death more rapidly than any other condition.
• An unconscious patient loses protective airway reflexes and muscle tone, making the airway highly vulnerable to obstruction by the tongue, blood, or secretions.
• Therefore, assessing and securing a patent airway (while maintaining cervical spine protection) is the essential first action before proceeding to breathing and circulation.

Why Other Options Were Wrong

• Option B: Starting ADH (Antidiuretic Hormone/Vasopressin) is not the initial intervention for trauma-induced hypotension. The primary cause is blood loss (hypovolemia), which must be treated with fluids and blood products first.
• Option C: A CT scan is a diagnostic procedure. Transporting an unstable patient with a compromised airway and circulation to a CT scanner is extremely dangerous and violates the 'treat first what kills first' principle.
• Option D: Infusing crystalloids addresses 'C' for Circulation. While the patient is hypotensive and clearly needs fluids, this action is futile if the patient cannot get oxygen into the lungs due to a blocked airway ('A') and then into the blood ('B').

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Prioritization of care in multiple trauma based on the ABCDE approach to guide bedside assessment, documentation, and the next nursing action.
• In any emergency setting, strict adherence to the ABCDE protocol is a core nursing competency that directly impacts patient survival. It provides a structured, reliable framework to manage chaos and prioritize life-saving interventions.
• Nurses are often the first to receive trauma patients and must be able to rapidly assess and initiate the ABCDE sequence, including preparing airway equipment, applying oxygen, and establishing IV access.
• What if the patient was conscious, alert, and complaining of abdominal pain, but with the same blood pressure? If the patient is talking, their airway is patent ('A' is clear). The immediate priority would then shift to 'C' - Circulation, involving rapid fluid resuscitation and controlling potential internal hemorrhage.

How to Approach the Question

• First, identify the question type. The word 'first' signals this is a priority question.
• Recognize the clinical context: 'unconscious patient' after a 'road traffic crash' with hypotension. This is a classic multiple trauma scenario.
• Recall the standard framework for trauma prioritization: the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach.
• Systematically evaluate each option against the ABCDE framework.
• Option A ('Patent airway') aligns with 'A' - the first step.
• Option D ('Infuse crystalloids') aligns with 'C' - the third step.

Concept Tested & Keywords

• Concept Tested: Prioritization of care in multiple trauma based on the ABCDE approach.
• Stem keywords: unconscious patient, road traffic crash, blood pressure 80/60 mm of Hg
• Lead-in keywords: first
• Clinical cues: The patient being 'unconscious' is a critical cue that the airway is at immediate risk.
• Clinical cues: The blood pressure of '80/60 mm of Hg' indicates hypovolemic shock, highlighting the need for circulation management, but only after airway and breathing are secured.

Question ID

QayY80QnHLPerHDDJHxRE1

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 pp. 616-618, 619-621

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 p. 120-122