This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
A case of blunt trauma is brought to the emergency, in a state of shock; he is not responding to IV crystalloids; next step in his management would be ? 
Select and explain. 
A. Immediate laparotomy, B. Blood transfusion, C. Albumin transfusion, D. Abdominal compression
A: Immediate laparotomy
Answer: A: Immediate laparotomy 
Explanation: Ans. is 'a' i.e., Immediate laparotomy This patient is not responding to IV crystalloids is likely to have a continuous source of bleeding. His abdomen is evaluated by an ultrasound (if available in the emergency depament) or by diagnostic peritoneal lavage (DPL), to rule out intrabdominal injuries as the source of blood loss & hypotension. If ultrasound or DPL are positive, then immediate laparotomy is done.