In case of accident as a nurse what would you first examine?

Appeared in: HPSSSB Staff Nurse - 2016

Explanation

In an emergency, the primary survey (ABCDE) dictates the order of assessment and intervention.
The 'A' in ABCDE stands for Airway, which is always the first priority.
An obstructed airway is the most immediate threat to life, as it stops oxygen supply to the brain, leading to death in minutes.
All other assessments, while important, are performed only after a patent airway has been established and secured.

Option B: Assessing for a fracture is part of 'E' (Exposure) in the primary survey or is addressed in the secondary survey. It is a much lower priority unless the fracture has caused a life-threatening arterial bleed.
Option C: Assessing for a possible head injury is part of 'D' (Disability) in the primary survey. It is assessed only after Airway, Breathing, and Circulation have been stabilized.
Option D: Controlling hemorrhage is part of 'C' (Circulation) in the primary survey. It is a critical step but comes after ensuring a patent airway ('A') and adequate breathing ('B').

Clinical Relevance

Nursing practice connection: Knowing Primary survey in trauma care (ABCDE approach) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
The ABCDE approach is the cornerstone of emergency and trauma nursing, providing a simple, reliable, and systematic way to manage critically ill patients and save lives.
Failure to follow this sequence can lead to missing a life-threatening airway obstruction while focusing on a more visible but less immediate injury like a fracture, resulting in a preventable death.
What if? If the patient is conscious and talking clearly without difficulty, it generally indicates a patent airway. In this case, the nurse can proceed more quickly to assessing 'B' (Breathing), but must remain vigilant for any signs of airway compromise, such as swelling or gurgling sounds.

How to Approach the Question

Identify the keywords in the question: 'accident' and 'first examine'. This indicates a question about priorities in an emergency.
Recall the standard protocol for initial assessment in trauma, which is the ABCDE primary survey.
List the steps of the ABCDE mnemonic: Airway, Breathing, Circulation, Disability, Exposure.
Match the options provided to the steps in the mnemonic.
Option A, 'Patent airway', corresponds to 'A' - the first step.
Options B (Fracture), C (Head injury), and D (Haemorrhage) correspond to E, D, and C, respectively, which all come after A.

Concept Tested & Keywords

QdxQkzGHIN_g6-G0L65APy

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 616-618

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 pp. 114-116, 120-122

Practise the full HPSSSB Staff Nurse - 2016

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