A 65-year-old man is brought to the emergency with a blast injury. He has bilateral lower limb amputations, evisceration, and impaired consciousness. Using ATLS principles, which injury should be addressed FIRST?

• A Evisceration — cover with saline-soaked dressing immediately
• B Airway with C-spine precautions, then catastrophic haemorrhage control with tourniquets
• C Bilateral lower limb tourniquets first (catastrophic haemorrhage), then airway ✓
• D Intubation first to protect the airway, then tourniquet application

Explanation

Per the C-ABCDE sequence from ATLS 10th edition, catastrophic haemorrhage control (C) is addressed first — bilateral traumatic lower limb amputations represent life-threatening external haemorrhage requiring immediate tourniquet application. The airway (A) is addressed next. The eviscerated bowel is a secondary survey finding that can be temporised with moist dressing after life-threats are controlled. This sequence reflects the principle that uncontrolled haemorrhage kills faster than airway compromise in most scenarios.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.