A patient brought into the emergency department with chest injury. After assessment finding reveals that ribs are fractured, active bleeding, SpO2 98%, BP 120/77 mm hg. What would be the priority action?

1. A

   Control of bleeding

2. B

   Treat rib fracture

3. C

   Administer O2

4. D

   Stabilization of the spine

Appeared in: NORCET -4 , 2023

Explanation

Listen in Hindi

• The primary survey in trauma prioritizes the most immediate life-threatening conditions.
• The C-ABC (Catastrophic hemorrhage, Airway, Breathing, Circulation) model dictates that uncontrolled external bleeding must be addressed first.
• This patient has 'active bleeding', which poses the most immediate risk of death from hypovolemic shock, even though the blood pressure is currently stable.
• The patient's airway and breathing are not compromised at this moment, as evidenced by the SpO2 of 98%.

Why Other Options Were Wrong

• Option B: Treating fractures is a secondary concern, addressed only after immediate life threats like massive bleeding or airway compromise are managed.
• Option C: The patient's oxygen saturation is 98%, which is within the normal range, indicating that there is no immediate need for supplemental oxygen as a priority action.
• Option D: While spinal immobilization is crucial in trauma, it does not take precedence over controlling a life-threatening hemorrhage. A patient will die from exsanguination before a potential spinal injury becomes the primary cause of death.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Prioritization of care in a trauma patient using the primary survey (ABCDE/C-ABC) framework in acute care settings.
• This question highlights the critical nursing skill of prioritization in the emergency setting, directly applying the principles of trauma resuscitation.
• The 'Stop the Bleed' initiative in public health underscores the importance of hemorrhage control as the first and most critical intervention in many trauma situations.
• What if the patient's SpO2 was 85% and they had paradoxical chest movement? In that case, the priority would shift to 'B' (Breathing) to address the flail chest and resulting respiratory failure, likely requiring immediate ventilatory support.

How to Approach the Question

• First, identify the question as a priority-setting problem in a clinical scenario.
• Recall the standard framework for trauma assessment, which is the primary survey (ABCDE or C-ABC).
• Analyze the patient data provided: 'active bleeding' (Circulation), 'fractured ribs' (Breathing/Disability), 'SpO2 98%' (Breathing), 'BP 120/77 mm hg' (Circulation).
• Apply the C-ABC framework: Is there Catastrophic hemorrhage? Yes, 'active bleeding'. This immediately becomes the highest priority.
• Evaluate the other options in light of this priority. Since Airway and Breathing are currently stable (SpO2 98%), and treating fractures/stabilizing the spine are secondary to preventing death from blood loss, controlling the bleeding is the correct choice.

Concept Tested & Keywords

• Concept Tested: Prioritization of care in a trauma patient using the primary survey (ABCDE/C-ABC) framework.
• Stem keywords: chest injury, fractured ribs, active bleeding, priority action
• Lead-in keywords: priority action
• Clinical cues: active bleeding
• Clinical cues: SpO2 98%

Question ID

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Copy ID

Reference Book

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

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 21-23