For a patient with a history of road traffic accident following is true:

Appeared in: BHU NO-2019

Explanation

In any high-impact trauma, such as a motor vehicle crash, a cervical spine injury must be assumed until proven otherwise.
This principle, known as spinal precaution, is critical to prevent movement that could convert a stable injury into an unstable one, causing permanent paralysis.
The immediate priority is to immobilize the spine before and during all other assessments and interventions.

Option A: Blood transfusion is part of 'Circulation' in the ABCDE trauma protocol, which is addressed after 'Airway' and 'Breathing'. Securing the airway is the first priority.
Option C: Tracheal intubation is not contraindicated; it is often necessary. The technique is modified to include manual in-line stabilization (MILS) to protect the cervical spine during the procedure.
Option D: The standard of care is to maintain the patient in a supine, neutral position on a backboard. Placing them in a lateral position can cause spinal rotation and worsen a potential injury.

Clinical Relevance

Nursing practice connection: Use the key finding related to Initial management and priorities in a trauma patient to guide bedside assessment, documentation, and the next nursing action.
A nurse's primary role in early trauma care is to maintain cervical spine immobilization at all times, including during patient transfers, assessments, and procedures like intubation.
The jaw-thrust maneuver, instead of the head-tilt-chin-lift, must be used to open the airway to avoid extending the neck.
What if the patient is unconscious and vomiting? The patient must be carefully log-rolled as a single unit by a team to clear the airway, while one person is dedicated solely to maintaining head and neck alignment. This prevents aspiration while protecting the spine.

How to Approach the Question

First, recognize that a 'road traffic accident' signifies a high-energy trauma, immediately raising suspicion for major injuries.
Recall the standardized protocol for initial trauma assessment: the ABCDEs (Airway, Breathing, Circulation, Disability, Exposure).
Evaluate each option based on this protocol. The 'A' for Airway always includes cervical spine protection as a simultaneous priority.
Option B, suspecting a cervical spine injury, is the foundational safety principle that underlies all initial actions in trauma.
Eliminate the other options: Blood transfusion (C) comes after A and B. Intubation (A) is not contraindicated, just modified. Lateral position (E) is incorrect for initial immobilization.

Concept Tested & Keywords

Concept Tested: Initial management and priorities in a trauma patient.
Stem keywords: road traffic accident, trauma
Lead-in keywords: true
Clinical cues: History of road traffic accident implies a high-energy impact and potential for multi-system trauma.

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Practise the full BHU NO-2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.