In an unresponsive patient with head injury, which assessment sequence should be performed first?

• A. Circulation, Airway, and Breathing
• B. Airway, Breathing, and Circulation
• C. Breathing, Circulation, and Airway
• D. Airway, Circulation, and Breathing

Answer: (A)

Airway protection takes priority in an unresponsive patient with head injury. When someone is unconscious, the tongue and facial injuries can quickly block the airway, so opening and protecting the airway must come first. Use techniques that minimize neck movement, like a jaw-thrust with inline cervical stabilization, and clear any secretions or blood with suction as needed. Only once the airway is open and patent do you assess and support breathing, providing rescue breaths or assisting with a bag–valve mask and high-flow oxygen as indicated. After breathing is adequately supported, focus on circulation—checking for signs of bleeding, establishing large-bore IV access, and monitoring vital signs to identify and treat shock. This order prioritizes preventing hypoxia, which can rapidly worsen brain injury, and ensures the patient is ventilated before filtering into circulation concerns. In cardiac arrest from trauma, the approach can differ, but for an unresponsive head-injured patient, Airway first, then Breathing, then Circulation is the guiding sequence.