Four clients were involved in a major highway motor vehicle accident. Which client requires priority care?

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11ecbb05_cbd9_027c_b433_45a2a743d549_MD0009_00 Tension pneumothorax causes marked compression and shifting of mediastinal structures (tracheal deviation), including the heart and great vessels, resulting in reduced cardiac output and hypotension. This is a life-threatening emergency. The client should have emergency large-bore needle decompression, followed by chest tube placement, to relieve the compression on the mediastinal structures. (Option B) Clients who have a head injury and lose consciousness are at high risk of intracranial injury (bleed). This client would likely need a head CT scan to assess for further damage, but the client with pneumothorax is the priority. (Option C) A grossly swollen upper thigh likely represents a femur fracture with extensive bleeding. It requires intervention, especially IV fluids and surgical correction. However, this is a second priority after the client with pneumothorax. (Option D) Thoracic spine pain and leg paralysis likely represent injury to the spinal cord. Precautions such as a hard cervical collar and backboard should be used to prevent further injury. This client requires further testing and treatment but is not a priority over the client with pneumothorax. Educational objective: Tension pneumothorax causes marked compression and shifting of mediastinal structures (tracheal deviation), including the heart and great vessels, resulting in reduced cardiac output and hypotension. This is a life-threatening emergency that requires urgent large-bore needle decompression followed by chest tube placement.

Four Clients Were Involved in a Major Highway Motor Vehicle