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An elderly patient aged 70 presented with a level I trauma after being struck by a motor vehicle traveling at unknown speed. The patient was found down and unresponsive by emergency medical services (EMS) with a Glasgow Coma Scale (GCS) score of 3 and was subsequently intubated. An intraosseous (IO) catheter was placed by EMS in the left proximal tibia and fluid resuscitation was started en route. On primary survey, the airway was secured with orotracheal intubation; bilateral breath sounds were auscultated; and correct placement was confirmed with end tidal CO2. Distal pulses were noted with a blood pressure of 135/70 mm Hg and a heart rate of 94 beats/min. The patient’s GCS score improved to 7T (E1V1TM5) in the trauma bay with localization to pain of the bilateral upper extremities. Pupils were 3 mm symmetric and reactive. Secondary survey was significant for bilateral periorbital hematomas and epistaxis, distended abdomen without signs of external trauma, and bilateral knee abrasions. Chest and pelvic X-rays failed to show displaced fractures. The patient was subsequently taken for complete body CT scan. A finding of moderate volume of air in the right ventricle (6 cm widest and 0.8 cm deepest) and main pulmonary …