A 24-Year-Old Man Is Brought to the Emergency Department After

question 538

Multiple Choice

A 24-year-old man is brought to the emergency department after being shot during a street fight.  On the way to the hospital, the patient became obtunded and required intubation.  He also received 2 L of normal saline.  On arrival, blood pressure is 86/40 mm Hg and pulse is 130/min.  The trachea is midline, and breath sounds are equal bilaterally.  Heart sounds are normal.  Two gunshot wounds are present: one in the left sixth intercostal space just lateral to the midclavicular line and another in the left seventh intercostal space posteriorly.  Portable chest x-ray shows irregular opacities at the left lung base.  Focused Assessment with Sonography for Trauma reveals no pericardial effusion and is equivocal for intraperitoneal free fluid.  Transfusion of uncrossmatched blood is pending.  Which of the following is the best next step in management of this patient?

• A)CT scan of the abdomen
• B)Diagnostic peritoneal lavage
• C)Exploratory laparotomy
• D)Local wound exploration
• E)Plain radiographs of the abdomen

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