You have a 5 year old patient who was struck by a car and initially was anxious, crying, HR 130, BP 90/50, RR 30. You rapidly package the patient, lay him supine on a backboard and cover him with blankets, give him a NRBM at 15lpm with a good mask seal even though you have to keep him from taking it off,control the minor bleeding from his lower leg wound and begin rapid transport. You had a 7 minute scene time and a 25 minute trip to a traumacenter. During transport, you attempt an 18 gauge IV and get it with little ﬁght from the patient. His BP is 80/60 and HR 150 with RR now 16.What can you determine from this repeat assessment?
His HR is up, his BP is down and the pulse pressure is narrowing plus he’s dropping his mental status (didn't ﬁght me on the IV!!!!!!) and even his RR is declining---he’s getting MUCH worse.