In a trauma patient with a right hemopneumothorax and pelvic fracture, who remains hypotensive after rapid fluid resuscitation, what is the next best step?

• A. Transfusion of Group O, Rh-negative packed red blood cells
• B. CT scan of chest and pelvis
• C. Administration of broad-spectrum antibiotics
• D. Observation and continued monitoring

Answer: (A)

In a trauma patient who remains hypotensive after rapid fluid resuscitation, the priority is to control hemorrhagic shock by restoring circulating blood and oxygen delivery. Transfusing blood products quickly is essential, and using Group O, Rh-negative packed red blood cells allows immediate transfusion without waiting for crossmatching, which is critical when time is fleeting and the patient may have ongoing bleeding from the pelvic fracture and chest injury. This approach buys time to address the sources of hemorrhage with definitive hemorrhage control, while imaging or delaying measures would not stabilize the patient. Broad-spectrum antibiotics or observation do not address the immediate need to replace lost blood, and delaying for a CT scan would worsen the shock.