Your Patient Is a 24-Year-Old Man Who Was Struck Just

Multiple Choice

Your patient is a 24-year-old man who was struck just below the left scapula with a 3-inch-diameter metal pipe. He is awake but having difficulty breathing. His pulse is 112 at the radial artery, and his respiratory rate is 28 per minute and shallow. His breath sounds are present bilaterally but diminished on the left. He has a blood pressure of 108/68. The patient is coughing up some bloody sputum. He has no other complaints, and a rapid trauma survey reveals no additional life-threatening injuries. Which of the following represents the best sequence of interventions for this patient?

A) Begin transport immediately, positive pressure ventilation, a large-bore IV of isotonic solution to maintain a systolic blood pressure of 120 mmHg or greater.
B) High-concentration oxygen by nonrebreather mask, begin transport, a 16-gauge IV at a keep-open rate.
C) Positive-pressure ventilation, a large-bore IV of normal saline solution at a keep-open rate, transport.
D) High-concentration oxygen by nonrebreather mask, begin transport, two 14-gauge IVs of 50 percent dextrose solution wide open.