You are transporting a young and healthy female patient who was involved in a motor vehicle collision, during which she struck her chest on the steering column. Although the primary assessment reveals no life threats, the patient does have redness to her sternum, as well as pain and tenderness. Breath sounds are clear and present bilaterally, and vital signs are within normal limits. As you transport and reassess this patient, which sign or symptom would indicate the immediate need for ALS?

A) Increased tenderness over sternum
B) New complaint of leg pain
C) Development of bruise over sternum
D) Onset of an irregular heartbeat

D) Onset of an irregular heartbeat