Dr. C. B. Sledge: A 49-year-old physician was brought to an outlying hospital by police 10 min after he was involved in an automobile accident. Initial examination revealed a semiconscious patient whose blood pressure was 132/80 mm Hg. His pulse rate was 100 beats per min, and his respiration rate was 22 per min. There was no evidence of gross external bleeding, respiratory obstruction, or localizing neurological signs. The patient's left thigh was deformed with an obvious fracture. The proximal left femoral shaft was visible, having pierced the skin, trousers, and overcoat. There was a closed fracture of the right femur and a deformity of the right knee. The right foot was contused and swollen with deformity of the medial four metatarsophalangeal joints. The right anterior chest was bruised and there was palpable crepitus in the region of the second to sixth ribs. Paradoxical motion was noted, but there was