A patient comes into the emergency department with trauma of chest and ribs and upper limb fracture. There is active bleeding from the trauma site. What would be the priority nursing action?

1. A

   Control the bleeding

2. B

   Treat rib fracture

3. C

   Place the arm in proper position

4. D

   Realign the fracture

Appeared in: NORCET -4 , 2023

Explanation

Listen in Hindi

• In a patient with multiple traumatic injuries, the presence of active hemorrhage is the most immediate threat to life.
• According to trauma management protocols like C-ABC (Catastrophic hemorrhage, Airway, Breathing, Circulation), controlling massive bleeding is the first and highest priority.
• Stopping the blood loss prevents the patient from progressing into hypovolemic shock, which can quickly lead to cardiovascular collapse and death.
• All other injuries, while serious, are addressed after the hemorrhage is controlled.

Why Other Options Were Wrong

• Option B: Treating a rib fracture addresses a 'Breathing' issue. While important, it is a lower priority than stopping massive, life-threatening hemorrhage which affects 'Circulation'.
• Option C: Positioning the arm is part of managing the fracture, which falls under the 'Disability' component of the trauma assessment. This is done during the secondary survey, after immediate life threats like hemorrhage are managed.
• Option D: Realigning a fracture is a definitive treatment, not an initial life-saving intervention. It is performed much later in the patient's care, often in the operating room, after the patient is fully stabilized.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Prioritization of nursing care in a multi-trauma patient in acute care settings.
• Nurses in emergency and trauma settings must be able to rapidly identify and manage catastrophic hemorrhage as the first step in resuscitation. This involves applying direct pressure, tourniquets, or hemostatic agents.
• Failure to prioritize hemorrhage control can lead to rapid deterioration and preventable death, even if other injuries are managed correctly.
• What if? If the patient had the same injuries but no active bleeding and was showing signs of severe respiratory distress with paradoxical chest movement, the priority would shift to 'Breathing'. The nurse would immediately suspect a flail chest or tension pneumothorax and intervene to support ventilation.

How to Approach the Question

• First, identify the question as a priority-setting question in a clinical emergency.
• Scan the patient's injuries: chest trauma, rib fracture, limb fracture, and active bleeding.
• Recognize that 'active bleeding' signifies a life-threatening hemorrhage.
• Recall the prioritization framework for trauma. The standard is ABC (Airway, Breathing, Circulation), but this is modified to C-ABC or MARCH when catastrophic hemorrhage is present.
• Apply the C-ABC framework: 'C' for Catastrophic hemorrhage comes first. Therefore, controlling the bleeding is the top priority.
• Evaluate the options: 'Control the bleeding' directly addresses the 'C' in C-ABC. The other options relate to 'B' (Breathing) and 'D' (Disability), which are addressed after hemorrhage is controlled.

Concept Tested & Keywords

• Concept Tested: Prioritization of nursing care in a multi-trauma patient.
• Stem keywords: trauma, chest, ribs, upper limb fracture, active bleeding
• Lead-in keywords: priority nursing action
• Clinical cues: The presence of 'active bleeding' is the most critical cue, indicating an immediate life threat that must be addressed first.

Question ID

QDHLvK6paRkBpiQRh-MwEE

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 pp. 120-122, 117-119

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