A 25-year-old male has a gunshot wound in his right chest. Your partner reports a weak, thready pulse. You see irregular, slow breathing. You should first:

• A. Open His Airway and Insert an OPA
• B. Cover the Wound With a Gloved Hand
• C. Assess for Jugular Vein Distention
• D. Assist His Ventilations With a BVM Attached to Oxygen

Answer: (B)

The primary priority in this scenario is stopping external hemorrhage. A gunshot wound to the chest with a weak, thready pulse signals significant blood loss and early shock risk. Controlling that bleeding immediately by applying direct pressure with a gloved hand helps limit continued blood loss and stabilizes the patient, which is the most time-critical step right now.

Airway and breathing are important and will be addressed next. The irregular, slow breathing suggests possible airway compromise or chest injury effects, so you would assess and support ventilation as needed (for example, with a bag-valve-mask if present). However, delaying bleeding control to focus on airway or ventilation first could allow life-threatening blood loss to continue.

Assessing for jugular venous distention could help you gauge conditions like tension pneumothorax or tamponade, but you don’t wait for that assessment before controlling bleeding. And while sealing a chest wound is important, the immediate, simplest way to reduce hemorrhage right away is direct pressure over the wound with a gloved hand.