Question: A 28-year-old man is brought to the emergency department after being involved in a high-speed motor vehicle collision. He was the restrained driver and was airlifted to the hospital due to the severity of his injuries. On arrival, his vital signs are as follows- blood pressure 100/50 mmHg, heart rate 130 beats per minute, respiratory rate 28 breaths per minute, oxygen saturation is 81%, is and he is minimally responsive. Physical examination reveals significant tenderness and guarding in the left upper quadrant of the abdomen. A Focused Assessment with Sonography for Trauma (FAST) exam is positive for free intraperitoneal fluid. His hemoglobin level has dropped from 14 g/dL pre-accident to 8 g/dL on admission. A CT Abdomen/Pelvis is obtained. His CT Report follows:   CT Abdomen and Pelvis with Intravenous Contrast      Clinical History:              28-year-old male involved in a high-speed motor vehicle collision.         Presents with hypotension (BP 75/45 mmHg), tachycardia (HR 130 bpm), left upper quadrant tenderness, and a significant drop in hemoglobin from 14 g/dL to 8 g/dL.         FAST exam positive for free intraperitoneal fluid.           Technique:              Multiphase contrast-enhanced CT scan of the abdomen and pelvis performed.         Intravenous contrast administered; arterial, venous, and delayed phases acquired.           Findings:      Spleen:              Laceration: Multiple deep lacerations noted in the mid and lower poles, extending to the hilum.         Active Bleeding: Active contrast extravasation within the splenic parenchyma observed on the arterial phase, indicating active hemorrhage.         Hematoma: Subcapsular and intraparenchymal hematomas present, measuring up to 5 cm in thickness.         Vascular Involvement: Possible involvement of the splenic artery branches with irregular contrast flow.           Liver:              No evidence of laceration, contusion, or active bleeding.           Kidneys:              No renal injuries detected.           Bowel and Mesentery:              No signs of bowel perforation, obstruction, or mesenteric injury.           Vascular Structures:              Active contrast extravasation from the distal splenic artery branch identified.         No evidence of aortic or other major vessel injury.           Peritoneal Cavity:              Significant hemoperitoneum present, predominantly in the left upper quadrant and pelvis, consistent with ongoing internal bleeding.           Bones:              No pelvic fractures or spinal injuries identified.           Other Organs:              Pancreas, gallbladder, and adrenal glands appear unremarkable.           Impression:              Grade IV Splenic Injury: Multiple deep lacerations involving the hilum with active contrast extravasation, indicative of ongoing hemorrhage.         Hemoperitoneum: Significant blood accumulation in the abdominal cavity, correlating with hemodynamic instability.         Active Bleeding: Evidence of active arterial bleeding from splenic vessels.           Conclusion:              The imaging findings are highly suggestive of a severe splenic injury with active hemorrhage.            What is the most appropriate next step in clinical management?
A. Order an abdominal MRI
B. Initiate aggressive intravenous fluid resuscitation and observe
C. Perform an emergent splenectomy
D. Schedule an elective laparoscopic surgery
E. Give oxygen
Answer: E