Surgery
A 25-year-old man brought to the Emergency Department unconscious with massive bleeding from stab wound in…
A 25-year-old man brought to the Emergency Department unconscious with massive bleeding from stab wound in the right thigh. On examination, he was pale with active bleeding from the stab wound (see lab result). Test Result Normal Value Hb 89 130-170 g/L Which of the following is the most important initial step in management?
Explanation
Core Concept: Advanced Trauma Life Support (ATLS) protocol strictly prioritizes the ABCs (Airway, Breathing, Circulation). An unconscious patient (GCS < 8) cannot protect their airway and requires definitive airway management before addressing hemorrhage or circulation.
Clinical Presentation:
- Unconsciousness, massive external hemorrhage, pallor, and signs of severe hypovolemic shock.
Diagnosis:
- First-line: Rapid primary survey (ABCDE assessment).
- Gold standard: Clinical assessment of airway patency and level of consciousness.
Management:
- Acute: Immediate orotracheal intubation to secure the airway and prevent aspiration. Simultaneously or immediately after, apply a tourniquet or direct pressure to control massive extremity hemorrhage, followed by activating the massive transfusion protocol.
- Long-term/Definitive: Surgical exploration and repair of vascular injuries.