A 45-yeаr-оld mаle is brоught tо the emergency depаrtment after being struck by a vehicle while crossing the street. On arrival, paramedics report he was found lying in the road, unresponsive to verbal commands. On assessment: He does not open his eyes spontaneously or to verbal command, but opens his eyes when a painful stimulus (sternal rub) is applied. He makes no verbal sounds at all, even with painful stimulation. When the painful stimulus is applied, he pulls his arm away from the pain but does not localize or attempt to remove the stimulus. Calculate this patient's total GCS score. Glasgow Coma Scale (GCS) Category Response Score Eye Opening (E) Spontaneous 4 To speech 3 To pain 2 No response 1 Verbal Response (V) Oriented 5 Confused 4 Inappropriate words 3 Incomprehensible sounds 2 No response 1 Motor Response (M) Obeys commands 6 Localizes pain 5 Withdraws from pain 4 Abnormal flexion (decorticate) 3 Abnormal extension (decerebrate) 2 No response 1
A 29-yeаr-оld femаle аt 32 weeks gestatiоn is brоught to the emergency department as a restrained driver involved in a moderate-speed motor vehicle collision. She reports abdominal pain and states she felt the car seatbelt "dig into" her lower abdomen on impact. On exam, she is tachycardic but normotensive. The abdomen is tender to palpation over the uterus, and the uterus is noted to be firm and contracting on palpation. There is a small amount of vaginal bleeding. Fetal heart tones are initially present but show late decelerations on monitoring. Primary and secondary trauma surveys are otherwise unremarkable, and initial maternal labs and FAST exam are negative for hemoperitoneum. What is the most appropriate next step in management?