An 80 year old man is brought to the ER following a motor vehicle crash. At the scene he had a blood pressure of 140/70, pulse 80/min. He was agitated and confused with a Glasgow Coma Score of 13. A single IV line was secured by EMS. C-spine precautions and backboard were used for transport to hospital. On arrival in ER, the BP and pulse were normal with respiratory rate of 34 and an oxygen saturation of 92% on 100% face mask oxygen. The GCS was still 13. On exam he had bruising to the right chest with an apparent flail segment. He had a laceration over the right parietal area. He had pain and a mobile pelvis on compression.