Penetrating Chest Trauma with Impalement

You are urgently directed to Resuscitation in a metropolitan Major Trauma Centre. A 24-year-old driver was in a motor vehicle accident between his car and a lorry carrying 12-cm diameter pine logs, with a log penetrating the windshield and impaling his right thorax. The time since injury is 25 minutes. He is fully conscious and in severe pain. His initial observations are: Heart rate 128 bpm Blood pressure 88/68 mmHg Respiratory rate 28 breaths per minute