Soru

A $28$-year-old woman is rushed to the emergency resuscitation bay after collapsing at a local shopping center. Emergency medical technicians report that she was initially responsive but became confused and profoundly lethargic during transport. According to her partner, she had been complaining of escalating, sharp right-sided pelvic pain over the past $24$ hours. Her last menstrual period was approximately eight weeks ago. Upon arrival, her temperature is $36.5^\circ\text{C}$ ($97.7^\circ\text{F}$), blood pressure is $72/40\text{ mmHg}$, heart rate is $142\text{/min}$, and respiratory rate is $24\text{/min}$. Physical examination demonstrates marked pallor, diaphoresis, and a rigid, distended abdomen with diffuse guarding. A rapid point-of-care urine pregnancy test is positive. Bedside focused assessment with sonography for trauma (FAST) reveals a massive amount of free fluid in the hepatorenal recess and the rectouterine pouch. Aggressive intravenous fluid resuscitation with crystalloids and uncrossmatched type O-negative packed red blood cells is immediately initiated through two large-bore peripheral catheters. Which of the following is the most appropriate next step in the management of this patient?