Surgery

A 25-year-old woman is brought to the emergency department with multiple gunshot wounds to her abdomen. Her blood pressure is 70 mm Hg. Her abdomen is massively distended. Large intravenous lines are placed, and a nasogastric tube and Foley catheter are inserted. The patient is brought immediately to the OR. After 2 L of normal saline, her blood pressure is 75/0 mm Hg, pulse rate is 140 bpm, and respiration rate is 30 breaths per minute. The next step in management should be which of the following?