Soru

An emergency medical services team transports a 42-year-old male construction worker to the trauma center after he fell approximately $6\text{ meters}$ ($20\text{ feet}$) from a scaffold. On arrival, the patient is confused and complains of severe left-sided abdominal pain and chest wall tenderness. His airway is patent. Initial vital signs demonstrate a temperature of $36.2^\circ\text{C}$ ($97.2^\circ\text{F}$), heart rate of $135/\text{min}$, respiratory rate of $26/\text{min}$, and blood pressure of $78/50\text{ mmHg}$. Symmetrical breath sounds are auscultated bilaterally. He receives a rapid intravenous infusion of $1\text{ L}$ of warmed crystalloid solution and $1\text{ unit}$ of uncrossmatched type O-negative packed red blood cells. Fifteen minutes later, his blood pressure improves to $112/68\text{ mmHg}$ and heart rate decreases to $98/\text{min}$. However, during the secondary survey, he becomes progressively more lethargic. Repeat vital signs show a heart rate of $138/\text{min}$ and a blood pressure of $82/45\text{ mmHg}$. An extended focused assessment with sonography for trauma (E-FAST) reveals a large anechoic collection in the splenorenal recess and no evidence of pneumothorax. Pelvic radiography shows no fractures. Arterial blood gas analysis on room air reveals a pH of $7.21$, $p\text{CO}_2$ of $34\text{ mmHg}$, and calculated bicarbonate of $14\text{ mEq/L}$. Which of the following is the most appropriate next step in the management of this patient?