Surgery · Trauma and Emergency Surgery (ATLS, Burns, Abdominal Trauma, Head Injury)

Following ATLS primary survey in a 45-year-old blunt trauma patient, the 'E' in the ABCDE sequence mandates full exposure and environmental control. Which specific potentially lethal injury is most frequently missed when this step is omitted?

A Open skull fracture
B Posterior penetrating thoracic wounds or perineal injuries ✓
C Tension pneumothorax
D Cervical spine fracture

Correct answer: B. Posterior penetrating thoracic wounds or perineal injuries

Explanation

The 'E' exposure step requires complete undressing of the patient and log-roll to examine the back, buttocks, and perineum — areas not visible during initial assessment. Posterior penetrating injuries (stab wounds, impalement) of the chest and perineal injuries (impalement, crush) are classic injuries missed without complete exposure. Tension pneumothorax and tracheal deviation are identified during breathing assessment (C). Skull fractures are detected during neurological examination. Cervical spine immobilization is initiated during airway management. Missed posterior thoracic wounds can result in delayed hemothorax or pneumothorax recognition.

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

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Written and medically reviewed by the StethoPrep medical team.

Following ATLS primary survey in a 45-year-old blunt trauma patient, the 'E' in the ABCDE sequence mandates full exposure and environmental control. Which specific potentially lethal injury is most frequently missed when this step is omitted?

Explanation

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