The correct answer is D. The utility of central lines are related to the nature of the injury or clinical condition of the patient. For example, internal jugular lines are useful when the shoulders or chest is going to be operated on. For this patient who likely has an inferior vena cava rupture, a precaval line does nothing except deliver blood product to his vena cava that promptly discharges it through a defect into the abdominal space. This patient is now in PEA because he has continued to lose volume through his defect. An upper extremity line should be placed (utilizes SVC) and volume should be delivered in that manner.
Attempting to bring the patient emergently to the operating room (choice A) could result in his death. Patients must be stabilized (the ABCs of resuscitation) before any additional interventions are taken. This patient is in an ACLS arrest and must be resuscitated prior to being discharged from the emergency department to the operating room.
For the reasons discussed above, to continue rapid transfusion of blood products and crystalloid via the femoral line (choice B) would be ineffective at restoring this patient's pressure.
Similarly, giving epinephrine intravenously (choice C) is not correct because this is only called for in pulseless VT or VF.
DC cardioversion at 200 Joules (choice E) is incorrect because this patient is in PEA arrest. This ACLS algorithm calls for interventions that restore the circulatory tone. There is no evidence that this patient is in pulseless ventricular tachycardia or fibrillation, which does call for countershock.
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