Question

A 42-year-old male was working at a construction site when a pallet of bricks fell onto him,

striking him in the chest. He is lying supine on a concrete floor. The bricks have been lifted off him
by coworkers. The patient responds to your voice, but he is anxious and confused. His skin is
mottled, especially above the shoulders, and cool. He is sweating profusely. His airway is open,
and he is breathing 34 times per minute with shallow breaths. He has a weak radial pulse of 130.
An examination of the chest reveals bruising, but no deformity, crepitus, or abnormal motion. The
best way to manage this patient until EMS arrives is to:
A) assist the patient into a semisitting position and have him hold a pillow against the injured
area; apply oxygen by nonrebreather mask.
B) manually stabilize the spine, assist breathing with a BVM and supplemental oxygen, and
continually reassess.
C) manually stabilize the spine, apply oxygen by nonrebreather mask, and elevate the legs 24 to
36 inches at the feet.
D) apply oxygen by nonrebreather mask, manually stabilize the spine, and secure a firm object,
such as a clipboard or book, over the injured area to límit movement of the flail segment.

Answer 1

Based on the given scenario, the best way to manage this patient until EMS arrives is to:

B) manually stabilize the spine, assist breathing with a BVM and supplemental oxygen, and continually reassess.

The patient is showing signs of a significant chest injury and possible internal bleeding, which can quickly lead to shock and respiratory failure. Manually stabilizing the spine will help prevent further injury during transport. Assisting breathing with a BVM (bag valve mask) and supplemental oxygen will help to support the patient's respiratory efforts and prevent hypoxia. Continually reassessing the patient's mental status, vital signs, and overall condition is important to monitor for any changes in status and adjust treatment as necessary.