Q. A 40-year-old female presents to the emergency department via ambulance following a motor vehicle accident in which she was an unrestrained passenger. She sustained multiple facial lacerations and has a visibly deformed right tibia-fibula fracture. A tourniquet was placed distal to the right patella to reduce blood loss from a suspected arterial source. The patient was described as alert and oriented at the scene, and was transported after appropriate immobilization. Paramedics report they were unable to obtain IV access, and that the patient had one episode of bloody emesis enroute to the hospital. Her past medical history is unknown at this time. On physical examination, the patient is coherent and asking about the status of her husband. Her blood pressure is 80/50 mm Hg, heart rate 90/min, respiratory rate 30/min. A 1 cm stellate laceration across the nasal bridge requires suction to prevent blood from entering the patient’s mouth. Chest auscultation demonstrates normal heart sounds, and markedly decreased breath sounds over the right lung field with associated dullness to percussion. Her abdomen is soft and nontender, and her pelvis appears stable. Despite the tourniquet, there is active bleeding from an 3 cm open wound on the right mid-tibial shaft. An arterial blood gas taken on arrival shows a pH 7.20, PaO2 60 mm Hg, PaCO2 80 mm Hg, HCO3 18 mEq/L. An emergent chest radiograph is also performed immediately upon arrival (see image). Based on the information you have at this point in time, which of the following interventions is the most appropriate next step?