Your unit is dispatched to a construction site for a blast-related injury. Fire department personnel arrive before you and radio to tell you that the scene is safe. On your arrival, you are informed that your patient is a 46-year-old man who had been blasting rock and had set the fuse too short. As he was leaving the area to seek cover from the explosion, he was blown forward onto a gravel area. He tells you that he remembers everything and did not have a loss of consciousness. He also indicates that the entire front of his body hurts and he cannot hear well.On examination, you find minor bleeding from his ears and some cuts and bruises to his arms. As you remove his clothing, you find that his chest and abdomen are bruised. He reports increasing pain and severe trouble breathing. As you begin your transport, you notice that he is now has hematemesis, cool and clammy skin, tachycardia, and hypotension.The minor bleeding from his ears is most likely an indication of:

You are dispatched to a motor vehicle crash on a rural road. On arrival you see a single vehicle in an embankment. The scene appears to be safe. The car has front-end damage and a starred windshield. You find an unrestrained driver sitting in the driver’s seat. He opens his eyes when you speak to him and is able to follow commands; however, he is confused and unable to tell you what happened. Examination reveals a laceration on the center of his forehead and a large bruise on his chest. Pulses and motor and sensory function are present in all extremities. His pulse is rapid, and breathing is slightly labored.What is your first concern in this situation?

You are called to an automotive body shop for a patient who has been physically assaulted. Law enforcement personnel have arrived and declared the scene safe. You and your partner find a 44-year-old man seated in an office holding the left side of his head. According to bystanders, the patient was struck on the side of his head with a tire iron during a dispute with another employee. He was unconscious for approximately 3 minutes.Which of the following are early signs of a head injury?

You are called to an automotive body shop for a patient who has been physically assaulted. Law enforcement personnel have arrived and declared the scene safe. You and your partner find a 44-year-old man seated in an office holding the left side of his head. According to bystanders, the patient was struck on the side of his head with a tire iron during a dispute with another employee. He was unconscious for approximately 3 minutes.When you secure this patient to a backboard, what area of the body should you secure last?

You are dispatched to a motor vehicle crash on a rural road where a single vehicle is up on an embankment. The vehicle has front-end damage and a starred windshield. The unrestrained driver is lying supine in the road; the police report that they found the patient outside of the vehicle. He is unconscious and has obvious facial bleeding. Examination reveals a hematoma and depression of the lefttemporal area, both eyes are black and blue, and one pupil is dilated, whereas the other is normal. The patient has blood coming from the nose and mouth, and palpation reveals subcutaneous emphysema around the clavicles and chest area. The patient’s breathing is labored, and the pulse is rapid and thready.The unequal pupils most likely indicate what type of injury?

You are dispatched to a motor vehicle crash on a rural road where a single vehicle is up on an embankment. The vehicle has front-end damage and a starred windshield. The unrestrained driver is lying supine in the road; the police report that they found the patient outside of the vehicle. He is unconscious and has obvious facial bleeding. Examination reveals a hematoma and depression of the lefttemporal area, both eyes are black and blue, and one pupil is dilated, whereas the other is normal. The patient has blood coming from the nose and mouth, and palpation reveals subcutaneous emphysema around the clavicles and chest area. The patient’s breathing is labored, and the pulse is rapid and thready.What is the priority for this patient?

You are dispatched to a private residence for a person reporting abdominal pain. You arrive to find a 25-year-old man lying on the couch in the fetal position. The patient states he was tackled while playing football 3 days ago and he now has pain that is becoming progressively worse. He is pale and diaphoretic. A physical examination of the abdomen shows bruising over the right and left upper quadrants, rebound tenderness, and guarding. The patient states the pain radiates to his right shoulder. Assessment of his vital signs shows a pulse rate of 130 beats/min, a blood pressure of 90/60 mm Hg, and respirations of 24 breaths/min.Bruising over the right upper quadrant could indicate injury to which of the following?

You and your partner are dispatched to the rodeo arena for a person reporting shortness of breath and chest pain. On arrival you are escorted to a first aid trailer where you find a man in his mid 30s seated in a chair and leaning forward clutching his chest. He tells you that he was riding a bull when he was thrown off. He states that he landed hard on his right side and heard a “loud pop.”While en route to the hospital, the patient suddenly grabs your arm and states that he can’t breathe. He appears pale, diaphoretic, and extremely anxious. Reassessment of the chest reveals diminished breath sounds on the right side and subcutaneous emphysema. You suspect which of the following conditions is developing in the patient?

You are dispatched to a private residence for a person reporting abdominal pain. You arrive to find a 25-year-old man lying on the couch in the fetal position. The patient states he was tackled while playing football 3 days ago and he now has pain that is becoming progressively worse. He is pale and diaphoretic. A physical examination of the abdomen shows bruising over the right and left upper quadrants, rebound tenderness, and guarding. The patient states the pain radiates to his right shoulder. Assessment of his vital signs shows a pulse rate of 130 beats/min, a blood pressure of 90/60 mm Hg, and respirations of 24 breaths/min.On the basis of your findings, which of the following best describes the patient’s condition?

You and your partner are dispatched to the rodeo arena for a person reporting shortness of breath and chest pain. On arrival you are escorted to a first aid trailer where you find a man in his mid 30s seated in a chair and leaning forward clutching his chest. He tells you that he was riding a bull when he was thrown off. He states that he landed hard on his right side and heard a “loud pop.”The patient finds it difficult to take a deep breath and speak. On the basis of this information, what should be your first intervention?