A 30-year-old male is brought to the emergency department after falling 4 meters from scaffolding. He is conscious and alert. Vital signs: BP 124/82 mmHg, HR 88 bpm. What is the first priority of management according to Advanced Trauma Life Support (ATLS) principles?

Answer and explanation

Correct answer: A. Airway maintenance with cervical spine protection

  1. Step 1: The core tenet of ATLS is the primary survey prioritizing life threats in ABCDE order:
  2. Step 2: A - Airway with cervical spine protection/immobilization;
  3. Step 3: B - Breathing and ventilation; C - Circulation with hemorrhage control; D - Disability; E - Exposure and environmental control.
  4. Step 4: Airway and cervical spine stabilization always takes precedence.
Answer
Airway maintenance with cervical spine protection.
Why not the others: 'Immediate secondary survey and neurological exam' is performed only after the primary survey (ABCDE) and initial resuscitation are complete; 'Infusion of 2 liters of warmed crystalloids' belongs to circulation assessment (C) and modern guidelines avoid large crystalloid boluses; 'Focused Assessment with Sonography for Trauma (FAST) scan' is an adjunct to circulation (C), not the first step.

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