Soru

A 67-year-old male is brought to the emergency department by ambulance due to the sudden onset of excruciating, diffuse abdominal pain that began one hour ago. He has a medical history of a mechanical aortic valve replacement for which he takes warfarin. Upon arrival, he appears pale, diaphoretic, and in severe distress. Temperature is $38.1^\circ\text{C}$ ($100.6^\circ\text{F}$), blood pressure is $82/48 \text{ mmHg}$, heart rate is $128/\text{min}$, and respiratory rate is $26/\text{min}$. Physical examination reveals a rigid, board-like abdomen with severe diffuse tenderness and rebound guarding. Bowel sounds are absent. An upright chest radiograph demonstrates crescent-shaped radiolucencies under both hemidiaphragms. Point-of-care laboratory testing reveals an international normalized ratio (INR) of $3.6$ and a serum lactate of $4.2 \text{ mmol/L}$. The surgical team is immediately consulted for an emergency exploratory laparotomy. Which of the following are mandatory concurrent steps in the immediate management of this patient? (Select all that apply)