In the emergency department, a client arrives after a bomb blast. Which sequence correctly lists the nursing actions from first to last?

• A. Establish airway; Protect cervical spine by maintaining alignment; Assess breath sounds and respiratory effort; Monitor blood pressure and pulse rate; Evaluate client's level of consciousness; Cover the client with a blanket.
• B. Protect cervical spine by maintaining alignment; Establish airway; Monitor blood pressure and pulse rate; Assess breath sounds and respiratory effort; Cover the client with a blanket; Evaluate client's level of consciousness.
• C. Establish airway; Assess breath sounds and respiratory effort; Protect cervical spine by maintaining alignment; Evaluate client's level of consciousness; Monitor blood pressure and pulse rate; Cover the client with a blanket.
• D. Evaluate client's level of consciousness; Establish airway; Protect cervical spine by maintaining alignment; Assess breath sounds; Monitor blood pressure and pulse rate; Cover the client with a blanket.

Answer: (A)

Trauma care follows the ABCDE sequence, addressing life-threatening issues in order of priority. The very first action is to secure a patent airway, because without airway protection the patient cannot be oxygenated. At the same time, cervical spine injury is a real possibility in blast victims, so maintaining spinal alignment during airway management is essential rather than delaying stabilization. Once the airway is secured with spine protection, evaluate breathing to assess adequacy, look for respiratory effort limits, and identify chest injuries that may need immediate intervention. After breathing is addressed, check circulation by monitoring blood pressure and pulse and looking for uncontrolled bleeding or signs of shock. Then assess the patient’s level of consciousness to gauge neurologic status. Finally, take steps to prevent hypothermia and provide comfort, such as covering with a blanket. This sequence ensures the most critical threats to life are managed first and that protection for the spine is maintained throughout.