A 30-year-old woman has an open deformity to her left leg and is in severe pain. She is conscious with a patent airway and breathing adequately. Your primary concern should be:

• A. Administer high-flow oxygen.
• B. Controlling external bleeding.
• C. Assessing pulses distal to the injury.
• D. Covering the wound to prevent infection.

Answer: (B)

Controlling external bleeding is the immediate priority. In trauma, after ensuring the airway and breathing are adequate, life-threatening hemorrhage takes precedence because rapid blood loss can lead to shock and death far more quickly than other injuries. For an open leg deformity, apply direct pressure with sterile dressings to stop the bleed, and escalate to a tourniquet only if direct pressure cannot control the bleeding. Once the bleeding is under control, reassess distal pulses and neurovascular status, and you can address wound coverage and other concerns. Oxygen can be provided, but it does not replace the need to stop the bleeding right away.