A patient who sustained a blow to the face is evaluated in your office. After confirming airway, breathing and circulation, which assessment takes priority?

Correct answer: D. Neurological evaluation for signs of head injury

• A. Soft-tissue repair is a definitive treatment step, undertaken only once life-threatening injuries have been excluded.
• B. Imaging follows the primary and secondary survey. A patient with a deteriorating level of consciousness must not be sent to the radiograph room.
• C. Occlusion and mobility are important for diagnosing fractures, but they are part of the local dental examination, which comes after systemic assessment.
• D. CORRECT. After the ABCs, the next priority in facial trauma is NEUROLOGICAL assessment — level of consciousness, pupillary response, orientation, amnesia, vomiting and cerebrospinal fluid leakage from the nose or ear. Facial trauma and intracranial injury travel together, and a missed head injury is life-threatening while a fractured tooth is not. Cervical spine injury must be assumed until cleared.

Note: Order of operations in facial trauma: ABCs → neurological status and cervical spine → hemorrhage control → secondary survey → imaging → definitive dental and soft-tissue care. Signs demanding immediate transfer: loss of consciousness, amnesia, unequal pupils, CSF rhinorrhea, Battle's sign, raccoon eyes.