A 35-year-old male involved in a high-speed motor vehicle collision presents with hypotension, abdominal distension, and flank bruising. During flight transport, which intervention is the highest priority?
Initiate balanced resuscitation with blood products and tranexamic acid (TXA).
Obtain a definitive airway to prepare for potential decompensation.
Administer a rapid 2-liter bolus of an isotonic crystalloid.
Perform a focused assessment with sonography for trauma (FAST) exam.
For a patient in hemorrhagic shock from suspected abdominal or retroperitoneal bleeding, the highest priority is hemorrhage control and restoration of circulating volume with blood products. Modern trauma guidelines emphasize a balanced resuscitation strategy using packed red blood cells, plasma, and platelets, along with tranexamic acid (TXA) to promote hemostasis and prevent the 'trauma triad of death' (acidosis, hypothermia, and coagulopathy). Large-volume crystalloid infusion is no longer recommended as an initial strategy because it can worsen coagulopathy through dilution, exacerbate acidosis, and contribute to hypothermia. While diagnostics like a FAST exam are crucial, they must not delay the initiation of life-saving resuscitation. Airway management is a key component of trauma care, but in this scenario, addressing the profound circulatory collapse is the most immediate priority based on the presented vital signs.
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