Correct!
4. 1 and 3

Initial assessment of a trauma victim is directed by the acronym ABCDE (1) where:

• A stands for Airway
• B stands for Breathing
• C stands for Circulation
• D stands for Disability and neurological Damage (Make a rapid neurological assessment -is the patient awake, vocally responsive to pain or unconscious?)
• E stands for Exposure (Undress the patient and look for injury. If you suspect a   neck or spinal injury, in-line immobilization is important)

The patient is pale suggesting potential blood loss. The declining oxygen saturation suggests possible trauma to the chest. Although the humeral fracture will need to be dealt with at some point, potential blood loss and chest trauma can be life-threatening and their evaluation should receive priority. A chest x-ray was taken but the patient arrested just after completion of the x-ray. She was intubated, but unfortunately vomited and aspirated during intubation. After several minutes of cardiopulmonary resuscitation spontaneous circulation returned. The chest x-ray became available (Figure 1).

Figure 1. Initial portable AP of chest taken immediately before cardiac arrest.

Which of the following should be done next? (Click on the correct answer to proceed to the third of six panels)

1. Administer high dose corticosteroids for aspiration pneumonia
2. Bronchoscopy to remove vomitus from the airways
3. Insert bilateral thoracostomy tubes
4. 1 and 3
5. All of the above

Home/Critical Care