Year Male Presents Explained for Students (Easy Guide)

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Original Question

A 23-year-old male presents to the emergency department by EMS after a gunshot wound to the abdomen. Vital signs include temperature of 98.6°F, pulse of 127 beats/min, respiratory rate of 24 breaths/min, blood pressure of 86/50 mmg and oxygen saturation of 100% on 2L of oxygen by nasal cannula. On physical examination, he is writhing in pain and gives one-word answers to questions. Clear breath sounds are present bilaterally. Cardiac exam reveals normal heart sounds, rapid rate and regular rhythm and no murmurs. Peripheral pulses are weak and thready. There is no echymosis, crepitus or deformity over the chest wall. A 1-liter warmed normal saline fluid bolus is given. There is no active external bleeding but there are three penetrating wounds to the right and left lower quadrants of the abdomen. The pelvis is stable with no abnormal movement when the iliac crests are compressed. The patient is noted to have urinary incontinence with hematuria, and blood is noted at the urethral meatus. Which of the following is the next best step in the management of this patient? (A) Computed tomography of the abdomen and pelvis (B) Exploratory laparotomy (C) Foley catheter placement (D) Retrograde cystogram (E) Retrograde urethrogram

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