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10602 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?

AOpen the abdomen and use a large Richardson retractor to compress the abdominal aorta against the vertebrae just below the diaphragm.
BPerform left thoracotomy, and cross-clamp the descending aorta just above the diaphragm.
CApply the PASG to elevate blood pressure before incision.
DInfuse 4 U of whole blood before incision.
Surgery
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