Your Patient Is an 80-Year-Old Man Who Was the Unrestrained

Multiple Choice

Your patient is an 80-year-old man who was the unrestrained driver of a vehicle without airbags that was involved in a frontal collision with a parked car. Your assessment reveals that he is dyspneic, tachypneic, and tachycardic. He is awake but unable to respond to questions. There are no obvious signs of injury to the head or neck. The patient has paradoxical movement of the sternum with breathing, along with crepitus and subcutaneous air noted on palpation. Chest excursion is limited, and the patient has cyanosis of his lips, ears, and nail beds. Which of the following is most needed in this patient?

A) Infusion of isotonic crystalloid solution using a large-bore IV
B) Application of bulky dressings over the site of paradoxical motion
C) Being placed in a prone position to stabilize the chest wall
D) Intubation and positive-pressure ventilation