According to the ATLS protocol, which of the following conditions takes first priority during the primary survey of a multiply injured patient?

• A Tension pneumothorax
• B Cardiac tamponade
• C Massive haemothorax
• D Airway obstruction with suspected cervical spine injury ✓

Explanation

The primary survey follows the mnemonic ABCDE, and airway maintenance with cervical spine protection is assessed before any other problem. Tension pneumothorax and massive haemothorax are identified during the Breathing assessment, and cardiac tamponade during the Circulation assessment, so they come after the airway even though each is immediately life threatening. The order exists because an obstructed airway kills within minutes, faster than uncontrolled haemorrhage.

Reference: ATLS Student Course Manual, American College of Surgeons, 10th ed.

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