A patient with a GCS of 13 and an aortic injury shows blood pressure fluctuations. What is the next step to manage?

In the context of a patient with a GCS of 13 and an aortic injury experiencing blood pressure fluctuations, management must prioritize addressing life-threatening injuries, particularly in a traumatic scenario. An exploratory laparotomy is indicated in situations where there is a suspected source of internal bleeding, especially when vital signs are unstable, as seen with blood pressure fluctuations in this case.

This surgical procedure allows for direct visualization and intervention in the abdomen to control hemorrhage, evaluate for additional injuries, and stabilize the patient. Given the life-threatening nature of an aortic injury and its potential to lead to rapid deterioration, immediate surgical intervention is crucial.

While other options like contrast angiography could be helpful for assessing vascular injury, they may delay necessary definitive treatment. Similarly, transferring the patient to a higher-level trauma center, while sometimes necessary, does not address the immediate need for surgical intervention in the presence of fluctuating blood pressures. Blood transfusion can be part of supportive management, but it also does not take the place of addressing the source of bleeding, which exploratory laparotomy will help accomplish.