A 28-year-old male struck in the chest during an altercation is conscious with severe chest pain, a large area of ecchymosis over the sternum, and a rapid, irregular pulse. In addition to providing supplemental oxygen, you should:

• A. Apply bulky dressings to the sternum.
• B. Prepare for immediate transport.
• C. Determine if he has cardiac problems.
• D. Apply an AED and assess his BP.

Answer: (B)

The main idea is that chest trauma with severe pain and signs like sternum ecchymosis and a rapid, irregular pulse requires rapid transport to definitive care after providing oxygen. In the field, you stabilize and support breathing, then move the patient to a facility where they can definitively evaluate and treat potential life-threatening injuries such as cardiac contusion, pneumothorax, or tamponade. Waiting to “determine if he has cardiac problems” isn’t practical or reliable in the prehospital setting, and delaying transport can worsen outcomes.

Bulky dressings over the sternum don’t address the underlying injury and could hinder assessment and transport. An AED is for someone without a pulse; this patient currently has a pulse, so defibrillation isn’t indicated now. Transport allows continuous monitoring, IV access, imaging, and treatment that can only be provided in an emergency department.