During the primary survey of a trauma patient, which component of the ABCDE assessment is evaluated FIRST?

Explanation

## Primary Survey: ABCDE Sequence **Key Point:** The primary survey follows a strict, life-threatening-first sequence. Airway is ALWAYS evaluated and managed first because airway compromise is immediately fatal. ### Rationale for Airway Priority The ABCDE algorithm is designed on the principle of **reversibility and immediacy of threat**: 1. **Airway obstruction** → death in minutes (hypoxia) 2. **Breathing failure** → death in minutes (hypoxia/hypercapnia) 3. **Circulation failure** → death in minutes (shock) 4. **Disability** → time-sensitive but not immediately fatal 5. **Exposure** → assessment and prevention of further injury **High-Yield:** Airway assessment includes: - Look, listen, feel for airway patency - Assess for stridor, gurgling, or absent breath sounds - Simultaneous cervical spine immobilization (assume C-spine injury in all trauma until proven otherwise) - Prepare for airway intervention (suction, positioning, airway adjuncts, intubation) **Clinical Pearl:** Even if the patient is speaking in full sentences, the airway must still be formally assessed and protected because deterioration can be rapid (e.g., airway edema, aspiration, loss of consciousness). **Mnemonic:** **ABCDE** = **A**irway (with C-spine), **B**reathing, **C**irculation, **D**isability, **E**xposure. The order is fixed and non-negotiable in ATLS. [cite:ATLS 10e]