A patient with a pelvic fracture develops chest pain, tachycardia, tachypnea, pallor, and petechiae. What action should the nurse implement first?

• A. Administer an analgesic
• B. Observe for hematuria
• C. Apply oxygen via mask
• D. Measure abdominal girth

Answer: (C)

The main concept is recognizing fat embolism syndrome after a fracture and prioritizing immediate oxygenation. The combination of chest pain, rapid breathing, rapid heart rate, pallor, and petechiae after a pelvic fracture strongly suggests fat droplets entering the bloodstream from the injured bone marrow, causing pulmonary involvement and hypoxemia. Providing oxygen via a mask is the first and most critical action because it directly improves arterial oxygenation and helps prevent hypoxic injury to the brain and other organs while further diagnostic and supportive steps are arranged. Analgesia, while important for comfort, does not address the life-threatening breathlessness and low oxygen levels. Observing for hematuria or measuring abdominal girth doesn’t target the urgent respiratory compromise presented here, so they’re not the immediate priority. If oxygenation remains inadequate, escalation to higher levels of respiratory support would be the next step.