A 45 year old woman is brought to the ED by car. You hear a squeal of brakes outside followed by a car accelerating away. When you go outside you find a 45 year old woman lying in the entrance to the department.

She is unresponsive, bradypnoeic and only has a weak central pulse. She is covered in blood.

You place her on a gurney and go to resus.

In resus:

A - patent, but not secure. Intubated with no drugs.
B - Air entry equal bilaterally. No added sounds.
C - Pulse 40. BP unrecordable.
D - Unresponsive. GCS 3.
E - Blood glucose 10.3

Examination shows gunshot wounds (low calibre) to the right shoulder, left thigh/buttock and the midback over T2 spinal process.

You take some blood gases.