For a patient with a low GCS score (8), airway protection and oxygenation are the top priority. Ensuring that the airway is open and maintaining oxygen saturation are critical to preventing further neurological damage. Once the airway is secured, a full trauma assessment and other interventions, such as obtaining vital signs or pain relief, can follow.
In the case of a suspected long bone fracture, such as a femur, pain control and immobilization of the limb are the first priorities. Pain relief will help reduce further trauma from muscle spasms. The extremity should be immobilized to prevent worsening of the injury. A neurovascular assessment is important but should be done after addressing the pain. Blood transfusion would only be indicated if there was significant blood loss.
Given the patient's history of a fall, confusion, and weakness, the primary concern should be a traumatic brain injury (TBI), such as a concussion or intracranial hemorrhage. A CT scan is the best tool to assess for these injuries. While checking for hypoglycemia and cervical spine injury is important in trauma cases, the priority is to rule out brain injury first. An ECG would not be the first step for this presentation.
This patient is presenting with signs of shock (pale, diaphoretic, hypotensive, tachycardic) likely due to blood loss from the abdominal stab wound. The immediate priority is fluid resuscitation to stabilize his circulation before other interventions, including surgery, can be performed. Administering pain medication and performing a detailed abdominal exam can follow once the patient’s vital signs are stabilized.
In spinal cord injury (SCI), especially in the cervical or upper thoracic regions, autonomic dysfunction can lead to hypotension and bradycardia, known as neurogenic shock. The appropriate intervention includes fluid resuscitation and atropine to manage these symptoms. Intubation and securing the airway may be necessary if the patient’s respiratory status worsens, but the immediate priority is addressing the hypotension and bradycardia.
