Trauma Case:
You are doing a ride-along with the regional paramedics in your area.  You respond to a motorcycle vs car accident.  On arrival, you are sent with one of the paramedics to evaluate the motorcycle rider and the other goes to evaluate the driver of the car.  
Your patient is a 23 years-old male with a fractured right femur with deformity and a bruised and tense abdomen.  His respiratory rate is 26, his heart rate is 120, and his blood pressure is 70 palpable.  According to protocol, 2 large-bore IVs are started with Normal Saline running wide open.  The driver of the car does not have any injuries.  Your patient is loaded into the ambulance and taken to the nearest hospital.  His vital signs do not improve on the way.
The local hospital does not have the surgical facilities this patient needs. You will take him to the regional medical center which is 50 miles away.  The doctor orders 4 units of O negative PRBCs.  2 are started in the ED the other two are sent with you for the trip.  The patient’s vital signs have not changed but the patients’ abdomen is grossly distended and hard.
On arrival at the medical center, a type and cross-match was done and the patient was taken to surgery. Before transporting the patient to the OR a unit of A+ PRBCs was started.  
After looking at Chapter 7, recalling what you learned in the blood typing lab, and what you can learn from other sources, answer the following questions:
1) Why were the heart rate and respiratory rate high and the blood pressure low?  What does that signify?
2) What is the likely status of oxygen saturation in the blood?
3) What function does the normal saline serve?  Why 2 large-bore IVs?
4) Why was O- blood given at the first hospital and on the way to the medical center?
5) Why was A+ blood given on the way to the OR?
6) Is the A+ blood or the O- blood likely to cause a reaction in this patient?
7) What would happen if this patient was given AB+ blood?
8) What would happen if this patient was given O+ blood? 
Can you think of any other treatment that this patient needed in the field?  In the first ED?  In the second ED before going to surgery?