An unconscious patient found lying supine has a large bruise on his upper-right abdominal quadrant. What is your primary concern?

The primary concern in this scenario is internal bleeding. When an unconscious patient is found with a significant bruise in the upper-right abdominal quadrant, it raises immediate suspicion for potential injuries to underlying organs, such as the liver or spleen, which can lead to internal hemorrhage. The presence of a bruise suggests that there has been recent trauma that may have compromised these structures, increasing the likelihood of internal bleeding.

Internal bleeding can lead to hypoperfusion as the body starts to lose blood volume, which can severely affect circulation and oxygen delivery to vital organs. However, while hypoperfusion is a critical condition that needs to be assessed, the immediate and most pressing concern is identifying and managing the potential source of that bleeding. Ensuring the airway is secure and monitoring for signs of shock should follow, but recognizing that internal bleeding is the likely cause of the bruise is fundamental to guiding treatment.

The other options may be relevant to assess depending on the patient's history and presentation but do not take precedence over the immediate threat of internal bleeding in this context. Spinal injury concerns are significant, but they do not directly connect to the bruise in the abdominal quadrant as much as internal bleeding does. Similarly, while drug overdose is a possibility for an unconscious patient,