Which of the following is the best next step in management of this patient?

A 24-year-old male with a history of gang violence presents to the emergency room with 3 stab wounds to the abdomen. He was intubated in the field for airway protection and is barely conscious. Blood pressure is 70/30 mm Hg and pulse is 140/min. On exam, 3 penetrating wounds covered by abdominal pressure pads are noted.

Which of the following is the best next step in management of this patient?
A . IV fluids
B . Abdominal x-ray
C . Obtain consent for surgery
D . IV antibiotics

View Answer

Answer: A

Explanation:

This patient is in hemorrhagic shock and requires immediate resuscitation. Of the choices listed, the best next step in management is IV fluids after obtaining venous access. The best form of venous access is 2 large-bore IVs in the periphery and/or central venous access. Applying direct pressure to the abdomen (a) does not treat the underlying cause. Getting an abdominal x-ray (b) will take too long for a patient with this rate of blood loss. IV antibiotics (c) may be needed later in the care of this patient, but stabilizing blood pressure is now the more urgent need. Surgical consent (e) is implied in a life-threatening emergency in which a patient cannot communicate his wishes.