A 22-year-old female was ejected from her car after striking a tree head-on. As you approach her, you note obvious closed deformities to both of her femurs. She is not moving and does not appear to be conscious. You should:

• A. Apply manual stabilization to both of her femurs.
• B. Assess for a carotid pulse and assist her ventilations.
• C. Administer oxygen and perform a rapid assessment.
• D. Stabilize her head and perform a primary assessment.

Answer: (D)

The key idea is protecting the spine first in a trauma patient with suspected neck injury and then performing a primary survey. With a high‑energy crash, an unconscious, unresponsive patient may have a cervical spine injury, so you immobilize the head and maintain in-line stabilization before moving or assessing deeper. Stabilizing the head prevents further spinal cord injury while you quickly evaluate airway, breathing, and circulation—the primary survey—to identify and manage life threats. Administering oxygen and other steps come as part of that rapid assessment, but without stabilizing the head, you risk worsening potential spinal injury.