An 80-year-old woman arrives at the ED by car after a fall down the stairs, colliding with the railing at the bottom. There is a bruise across her abdomen and lower chest. She is groaning loudly and seems confused. Although she complains of distinct abdominal and left shoulder pain, she cannot tell you what has happened or why she fell, where she is at present, or what day of the week it is, although she can tell you her full name. You note a shallow, rapid breathing pattern of 26 breaths/min; her systolic BP is 90 mm Hg; and her pulse rate is 70 bpm and regular. How would you prioritize the patient’s needs? Develop an assessment strategy and identify diagnostic studies that will benefit the patient. In light of the injury pattern, respiratory rate, and blood pressure, can you give a plausible explanation why her pulse rate is not elevated?
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