A 52-year-old man complains of vomiting and diarrhea for the past day. He isconscious and alert, has a blood pressure of 130/70 mm Hg, has a heart rate of120 beats/min and strong, and has respirations of 20 breaths/min and regular.His past medical history is significant for anemia and congestive heart failure.Prior to administering isotonic crystalloid solutions to this patient, it isMOST important to:
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A 38-year-old man presents with an acute onset of severe right upper quadrantabdominal pain, pain to his right shoulder, and nausea. He is conscious andalert, but is restless from the pain. His blood pressure is 150/86 mm Hg, pulserate is 120 beats/min and strong, and respirations are 22 breaths/min andregular. In addition to administering supplemental oxygen, you should:A) start an IV with normal saline and set it to keep the vein open, place him ina position of comfort, and administer 4 mg of morphine and 12.5 mg ofpromethazine.B) encourage him to remain supine to relieve his pain, monitor his oxygensaturation level, and administer 10 to 20 mg of Nubain via the IM route.C) establish vascular access with a large-bore catheter, administer a 500-mLnormal saline bolus, and avoid analgesics due to the potential for intra-abdominal bleeding.D) perform a comprehensive abdominal exam, start at least one large-bore IVline, infuse normal saline at 125 mL/hr, and consider giving him an antiemeticmedication.