A nurse responds to a 32-year-old client found unresponsive after a motor vehicle crash. Place the following primary survey assessment steps in the correct ABCDE order from first (1) to last (5).
Ordered Response
Choose your responses, then check the answer.
Explanation
The ABCDE primary survey is the international standard for rapid emergency assessment, used in trauma (ATLS), medical emergencies, and ACLS. The order reflects the time to death from each problem if untreated: an obstructed airway kills in minutes, breathing failure shortly after, then circulatory collapse, then neurologic injury, then environmental exposure. (A) Airway with C-spine protection if trauma — open the airway with a jaw thrust (not head tilt) when neck injury is suspected. (B) Breathing — RR, effort, oxygen saturation, breath sounds, chest rise. (C) Circulation — pulse, BP, capillary refill, obvious bleeding; control major hemorrhage. (D) Disability — brief neuro exam: LOC, pupils, AVPU or GCS, glucose. (E) Exposure — fully examine while preventing hypothermia (warm blankets, warm fluids, raise room temperature).
ABCDE Primary Survey International standard for rapid emergency assessment.
Sequence and Rationale A — Airway with C-spine if trauma. Obstruction is fatal in minutes. B — Breathing: RR, effort, SpO2, breath sounds, symmetry. C — Circulation: pulse, BP, perfusion, control hemorrhage. D — Disability: LOC, pupils, AVPU or GCS, glucose. E — Exposure: full exam, prevent hypothermia.
Trauma Adaptations - C-spine immobilization throughout - Jaw thrust (not head tilt) for suspected neck injury - Tourniquet for life-threatening limb hemorrhage - Permissive hypotension in some bleeding scenarios - Warming during exposure (Stop the Bleed)
When to Repeat - After every intervention - After deterioration - During continuous monitoring
NCSBN Theme ROR — Reduction of risk and emergency assessment.
Scenario32-year-old client found unresponsive after MVC.
RequiredPrimary survey 5 steps in correct ABCDE order from first (1) to last (5).
PrincipleTreat what kills first. Address findings before moving to the next letter.
ABCDE primary survey — Standardized rapid emergency assessment protocol used in trauma (ATLS), medical emergencies, ACLS, and EMS. Order reflects mortality time: A (airway) under minutes, B (breathing) minutes, C (circulation) minutes, D (disability) hours, E (exposure) hours to days. Each letter is addressed and any life-threatening problem stabilized before progressing. The survey is repeated after every intervention and any patient deterioration.
AVPU vs GCS — AVPU is a rapid level-of-consciousness scale: Alert, Verbal response, Pain response, Unresponsive. Used during primary survey for speed. Glasgow Coma Scale (GCS, range 3 to 15) is more detailed (eye opening, verbal, motor) and used during secondary survey or when AVPU finds altered LOC. GCS under 8 generally indicates intubation for airway protection.
Hypothermia prevention in trauma — The lethal triad in major trauma: hypothermia, acidosis, coagulopathy. Hypothermia worsens coagulation and increases mortality. Prevention during exposure: warm blankets, warmed IV fluids (39 to 42 C), warmed blood products, room temperature 24 to 27 C, remove only as needed, replace clothing or warm coverings as soon as exam done.