MSFinals-6695

MSFinals-6695

A 29-year-old man has been assaulted with a baseball bat. He is brought to the Emergency Department as a major trauma ‘code red’ call. He has already had drug-assisted intubation at the scene and a thoracostomy to his left chest. He remained critical throughout the journey to hospital, receiving intravenous (IV) fluids and 2 units of O-negative red blood cells. On primary survey, he has equal chest expansion, but with crepitus and clear injuries to his left chest. He is tachycardic at 160 bpm, with an unrecordable blood pressure (BP). On further exposure, he has multiple marks over his abdomen and torso, and a distended, tense abdomen. A FAST scan is positive, with free fluid in the abdomen. A concurrent chest X-ray shows fractured ribs on the left, but otherwise clear lung fields, without haemothorax. He has now received 3 units of packed red cells and 2 units of fresh frozen plasma, along with 2 litres of crystalloid fluid. Following these interventions, his BP is recorded at 74 mmHg systolic, and he remains unstable.
What would be the next most appropriate management step?