A young male has a large laceration to his lateral neck, directly over his jugular vein. Your MOST immediate priority should be to:

• A. Keep air out of the wound and control the bleeding.
• B. Apply high-flow oxygen via a nonrebreathing mask.
• C. Obtain vital signs to determine if he is hypotensive.
• D. Perform a rapid assessment to detect other injuries.

Answer: (A)

The priority is stopping a life-threatening bleed from a neck wound and preventing air from entering the vasculature. A large laceration over a jugular vein can bleed heavily and, if air is drawn into the open vessel, air embolism can occur. The immediate action is direct pressure on the wound and sealing it with an occlusive dressing to control bleeding and minimize air entry. Oxygen and vital-sign checks are important, but they don’t take precedence over stopping this major hemorrhage. While you should assess for other injuries and monitor the patient, bleeding control at the neck is the first and most critical step. If airway compromise arises, manage the airway promptly, but do not delay wound management to check vitals or give oxygen.