An elderly patient has fallen and hit her head. Your initial care should focus on:

• A. obtaining baseline vital signs.
• B. airway, breathing, and circulation.
• C. providing immediate transport.
• D. gathering medical history data.

Answer: (B)

In trauma care, the highest priority is preserving life by maintaining the patient’s airway, breathing, and circulation. After a head injury, this becomes even more critical because brain tissue is highly vulnerable to hypoxia and reduced perfusion; any delay in securing oxygen delivery can lead to irreversible brain damage.

Airway: A compromised airway can quickly lead to obstruction from decreased consciousness, facial injuries, or secretions. Ensuring a patent airway (and using maneuvers or devices as needed) is essential to keep oxygen moving to the brain.

Breathing: After head trauma, respiratory status may deteriorate if brain injury affects the brainstem or if pain, fear, or airway obstruction impair ventilation. Providing supplemental oxygen and assisting ventilation as needed helps maintain adequate oxygen levels.

Circulation: Adequate blood flow to the brain is vital. Hypotension or shock reduces cerebral perfusion and worsens outcomes after head injury; recognizing and treating circulation problems helps protect brain tissue.

While obtaining baseline vitals, gathering medical history, or arranging transport are important steps, they do not take precedence over keeping the airway clear, ensuring adequate breathing, and maintaining circulation. Stabilize ABCs first, then proceed with other assessments and rapid transport.