Page 1 of 55
ATLS 10TH EDITION XABCDE TRAUMA PRIORITIZATION
EXAM – WHAT COMES FIRST? XABCDE PRIORITIZATION
EXSANGUINATING HEMORRHAGE, AIRWAY,
BREATHING, CIRCULATION, DISABILITY, EXPOSURE
Trauma / Primary Survey Prioritization / Clinical / Nursing
Exam coverage:
❖ Section 1 (Q1–10): Foundations of xABCDE, including the
correct sequence and rationale for prioritizing hemorrhage
control.
❖ Section 2 (Q11–30): Exsanguinating hemorrhage (x), including
tourniquet application, wound packing, and junctional
hemorrhage control.
❖ Section 3 (Q31–45): Airway (A), including airway adjuncts,
intubation, and surgical airway.
❖ Section 4 (Q46–60): Breathing (B), including tension
pneumothorax, open pneumothorax, massive hemothorax,
and flail chest.
❖ Section 5 (Q61–75): Circulation (C), including shock types,
pelvic binder application, and resuscitation strategies.
❖ Section 6 (Q76–85): Disability (D), including GCS scoring, TBI
classification, and CT indications.
, Page 2 of 55
❖ Section 7 (Q86–95): Exposure (E), including log rolling and
hypothermia prevention.
❖ Section 8 (Q96–100): Integrated scenarios and definitive care,
including surgical indications and transfer.
Section 1: Foundations of xABCDE Prioritization (Questions
1–10)
Question 1
A trauma team is reviewing the primary survey sequence in the
ATLS 10th Edition. The team leader must understand the correct
order of priorities. Which of the following represents the correct
xABCDE sequence?
A. A-B-C-D-E
B. C-A-B-C-D-E
C. x-A-B-C-D-E
D. B-A-C-D-E
CORRECT ANSWER: C ✅
RATIONALE: The ATLS 10th Edition uses the xABCDE sequence,
where "x" represents control of exsanguinating external
hemorrhage, followed by A (Airway), B (Breathing), C
(Circulation), D (Disability), and E (Exposure). Option A is the
traditional sequence without "x." Option B is not a recognized
sequence. Option D incorrectly places breathing before airway.
Question 2
A trauma patient arrives with catastrophic external hemorrhage
from a femoral artery injury. According to the xABCDE
algorithm, which of the following should be performed first?
A. Assess the airway
B. Control the hemorrhage with direct pressure or tourniquet
, Page 3 of 55
C. Start two large-bore IV lines
D. Perform a secondary survey
CORRECT ANSWER: B ✅
RATIONALE: In the xABCDE algorithm, control of life-
threatening external hemorrhage (x) takes priority over airway
assessment. Direct pressure or a tourniquet should be applied
immediately. Option A is incorrect because airway assessment
comes after hemorrhage control. Option C is incorrect because
IV access does not stop active bleeding. Option D is incorrect
because the secondary survey is performed after the primary
survey.
Question 3
A trauma team leader is teaching new residents about the
rationale for prioritizing hemorrhage control before airway
management. Which of the following best describes this
rationale?
A. Airway obstruction is always immediately fatal
B. Uncontrolled hemorrhage is the leading cause of preventable
trauma death
C. Airway management requires more skill than hemorrhage
control
D. Hemorrhage control is easier to perform
CORRECT ANSWER: B ✅
RATIONALE: Uncontrolled hemorrhage is the leading cause of
preventable trauma death, and evidence shows that prioritizing
circulation before airway in patients with exsanguinating injuries
can improve survival. Option A is incorrect because hemorrhage
is more statistically preventable. Option C is incorrect because
the rationale is physiological, not skill-based. Option D is
, Page 4 of 55
incorrect because the rationale is based on mortality data, not
ease of procedure.
Question 4
A trauma patient has a GCS of 15 but has active bleeding from a
scalp laceration. According to xABCDE, what is the first priority?
A. Assess the airway
B. Control the scalp hemorrhage
C. Obtain a CT scan of the head
D. Administer pain medication
CORRECT ANSWER: B ✅
RATIONALE: In the xABCDE algorithm, control of
exsanguinating external hemorrhage (x) takes priority over
airway and other assessments. Scalp lacerations can bleed
profusely and lead to hemodynamic compromise. Option A is
incorrect because hemorrhage control precedes airway. Option
C is incorrect because imaging is not the first priority. Option D
is incorrect because pain management is not the initial priority.
Question 5
A trauma team leader is explaining the difference between "x"
and "C" in the xABCDE algorithm. Which of the following best
describes the distinction?
A. "x" addresses external hemorrhage; "C" addresses internal
hemorrhage
B. "x" addresses internal hemorrhage; "C" addresses external
hemorrhage
C. Both address external hemorrhage
D. Both address internal hemorrhage
CORRECT ANSWER: A ✅
RATIONALE: In the xABCDE algorithm, "x" addresses life-
ATLS 10TH EDITION XABCDE TRAUMA PRIORITIZATION
EXAM – WHAT COMES FIRST? XABCDE PRIORITIZATION
EXSANGUINATING HEMORRHAGE, AIRWAY,
BREATHING, CIRCULATION, DISABILITY, EXPOSURE
Trauma / Primary Survey Prioritization / Clinical / Nursing
Exam coverage:
❖ Section 1 (Q1–10): Foundations of xABCDE, including the
correct sequence and rationale for prioritizing hemorrhage
control.
❖ Section 2 (Q11–30): Exsanguinating hemorrhage (x), including
tourniquet application, wound packing, and junctional
hemorrhage control.
❖ Section 3 (Q31–45): Airway (A), including airway adjuncts,
intubation, and surgical airway.
❖ Section 4 (Q46–60): Breathing (B), including tension
pneumothorax, open pneumothorax, massive hemothorax,
and flail chest.
❖ Section 5 (Q61–75): Circulation (C), including shock types,
pelvic binder application, and resuscitation strategies.
❖ Section 6 (Q76–85): Disability (D), including GCS scoring, TBI
classification, and CT indications.
, Page 2 of 55
❖ Section 7 (Q86–95): Exposure (E), including log rolling and
hypothermia prevention.
❖ Section 8 (Q96–100): Integrated scenarios and definitive care,
including surgical indications and transfer.
Section 1: Foundations of xABCDE Prioritization (Questions
1–10)
Question 1
A trauma team is reviewing the primary survey sequence in the
ATLS 10th Edition. The team leader must understand the correct
order of priorities. Which of the following represents the correct
xABCDE sequence?
A. A-B-C-D-E
B. C-A-B-C-D-E
C. x-A-B-C-D-E
D. B-A-C-D-E
CORRECT ANSWER: C ✅
RATIONALE: The ATLS 10th Edition uses the xABCDE sequence,
where "x" represents control of exsanguinating external
hemorrhage, followed by A (Airway), B (Breathing), C
(Circulation), D (Disability), and E (Exposure). Option A is the
traditional sequence without "x." Option B is not a recognized
sequence. Option D incorrectly places breathing before airway.
Question 2
A trauma patient arrives with catastrophic external hemorrhage
from a femoral artery injury. According to the xABCDE
algorithm, which of the following should be performed first?
A. Assess the airway
B. Control the hemorrhage with direct pressure or tourniquet
, Page 3 of 55
C. Start two large-bore IV lines
D. Perform a secondary survey
CORRECT ANSWER: B ✅
RATIONALE: In the xABCDE algorithm, control of life-
threatening external hemorrhage (x) takes priority over airway
assessment. Direct pressure or a tourniquet should be applied
immediately. Option A is incorrect because airway assessment
comes after hemorrhage control. Option C is incorrect because
IV access does not stop active bleeding. Option D is incorrect
because the secondary survey is performed after the primary
survey.
Question 3
A trauma team leader is teaching new residents about the
rationale for prioritizing hemorrhage control before airway
management. Which of the following best describes this
rationale?
A. Airway obstruction is always immediately fatal
B. Uncontrolled hemorrhage is the leading cause of preventable
trauma death
C. Airway management requires more skill than hemorrhage
control
D. Hemorrhage control is easier to perform
CORRECT ANSWER: B ✅
RATIONALE: Uncontrolled hemorrhage is the leading cause of
preventable trauma death, and evidence shows that prioritizing
circulation before airway in patients with exsanguinating injuries
can improve survival. Option A is incorrect because hemorrhage
is more statistically preventable. Option C is incorrect because
the rationale is physiological, not skill-based. Option D is
, Page 4 of 55
incorrect because the rationale is based on mortality data, not
ease of procedure.
Question 4
A trauma patient has a GCS of 15 but has active bleeding from a
scalp laceration. According to xABCDE, what is the first priority?
A. Assess the airway
B. Control the scalp hemorrhage
C. Obtain a CT scan of the head
D. Administer pain medication
CORRECT ANSWER: B ✅
RATIONALE: In the xABCDE algorithm, control of
exsanguinating external hemorrhage (x) takes priority over
airway and other assessments. Scalp lacerations can bleed
profusely and lead to hemodynamic compromise. Option A is
incorrect because hemorrhage control precedes airway. Option
C is incorrect because imaging is not the first priority. Option D
is incorrect because pain management is not the initial priority.
Question 5
A trauma team leader is explaining the difference between "x"
and "C" in the xABCDE algorithm. Which of the following best
describes the distinction?
A. "x" addresses external hemorrhage; "C" addresses internal
hemorrhage
B. "x" addresses internal hemorrhage; "C" addresses external
hemorrhage
C. Both address external hemorrhage
D. Both address internal hemorrhage
CORRECT ANSWER: A ✅
RATIONALE: In the xABCDE algorithm, "x" addresses life-
