In treating life threatening conditions, following steps need to be taken in logical sequence.
(I) Control bleeding
(II) Treat shock
(III) Check breathing
(IV) Use of head tilt method, if airway is obstructed
Select the correct answer using the code given below:

1. A

   III, IV, I, II

2. B

   I, II, III, IV

3. C

   II, I, III, IV

4. D

   IV, III, II, I

Appeared in: UPPSC 2023

Explanation

• The correct sequence follows the principles of the primary survey in emergency care, commonly known as ABC (Airway, Breathing, Circulation).
• First, breathing is assessed (Step III). If there is an issue, the airway must be opened immediately (Step IV). This establishes a path for oxygen.
• Once airway and breathing are secured, the focus moves to circulation. The most urgent circulatory problem is severe bleeding, which must be controlled (Step I).
• Finally, after stopping the hemorrhage, the resulting condition of shock is treated (Step II). Treating shock before controlling bleeding is ineffective.

Why Other Options Were Wrong

• Option B: This sequence (I, II, III, IV) incorrectly prioritizes circulation (bleeding and shock) before airway and breathing. A patient cannot survive without a patent airway, regardless of circulatory status.
• Option C: This sequence (II, I, III, IV) is incorrect because it attempts to treat shock before controlling the bleeding that is causing it. This is futile as the patient will continue to lose blood volume.
• Option D: This sequence (IV, III, II, I) incorrectly places treating shock (II) before controlling bleeding (I). It also reverses the initial assessment, suggesting opening the airway before checking if breathing is even a problem.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Primary Survey in Emergency Management (ABCDE Approach) as background academic context rather than a clinical decision trigger.
• Nurses are often the first responders in a hospital setting when a patient's condition deteriorates. Knowing the correct ABCDE sequence is critical for rapid response teams and in emergency departments to save lives.
• This systematic approach prevents cognitive overload in a crisis, allowing the nurse to focus on the most life-threatening problem at each step without getting distracted by less critical injuries.
• What if? If the patient had a massive, spurting arterial bleed from a limb upon initial approach? In this specific case of catastrophic hemorrhage, the protocol may shift to ABC, where the first action is to apply a tourniquet to control the bleeding (C), and then immediately proceed to Airway (A) and Breathing (B).

How to Approach the Question

• Identify the question as a process or sequence-based question. It asks for the logical order of actions.
• Recall the fundamental principle of emergency care: the primary survey, or ABC (Airway, Breathing, Circulation).
• Map each of the four given steps to the ABC framework.
• Step III (Check breathing) and Step IV (Head tilt) relate to Airway and Breathing (A & B). Assessment (checking) comes before intervention (head tilt).
• Step I (Control bleeding) and Step II (Treat shock) relate to Circulation (C). Stopping the leak (bleeding) must come before refilling the system (treating shock).
• Assemble the steps in the logical ABC order: Assess Breathing (III), then manage Airway (IV), then manage Circulation by controlling bleeding (I) and then treating shock (II).

Concept Tested & Keywords

• Concept Tested: Primary Survey in Emergency Management (ABCDE Approach)
• Stem keywords: life threatening conditions, logical sequence, control bleeding, treat shock, check breathing, head tilt method
• Lead-in keywords: Select the correct answer

Question ID

QrP9p9owOkozNWwIth2GOJ

Copy ID

Reference Book

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

E6 Comprehensive Textbook of Community Health Nursing for BSc Nursing Students Part 2 — Subpart A (pp 1-275 of 550) p. 181-183