A 21 year old male is semi-conscious at the bottom of two flights of stairs. What is the first step you should take?

In this scenario, the priority is to ensure that the potential for a spinal injury is managed correctly. The patient is found semi-conscious at the bottom of two flights of stairs, which raises a significant concern for possible head or spinal injuries due to the mechanism of the fall.

Manually stabilizing the cervical spine is critical because any movement of the head or neck could exacerbate a potential spinal injury. Stabilization helps to prevent any further damage while you assess the patient and provide care. After ensuring that the cervical spine is stabilized, the next steps would typically involve assessing the airway and breathing as well as determining the level of consciousness.

Other interventions, such as performing a sternal rub, may assess responsiveness but can risk compromising the neck if the spine is not stabilized first. Additionally, assessing distal pulses is important for overall circulation but is secondary to ensuring the spinal integrity and safety of the patient in this specific context. Opening the airway is essential, but without stabilizing the c-spine first, there is a risk of further injuring the spine during the maneuver. Thus, prioritizing c-spine stabilization is the appropriate first step.