<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 41-year-old man is admitted to the emergency room after being struck in the abdomen by a large cement plate while transporting it. On initial assessment by paramedics at the scene, his blood pressure was 11080 mm Hg, heart rate 85min, with no signs of respiratory distress. On admission, the patient is alert but in distress. He complains of severe, diffuse, abdominal pain and severe weakness. Vital signs are now: blood pressure 9050 mm Hg, heart rate 96min, respiratory rate 19min, temperature 37.4C 99.3F, and oxygen saturation of 95 on room air. His lungs are clear on auscultation. The cardiac exam is significant for a narrow pulse pressure. Abdominal examination reveals a large bruise over the epigastric and periumbilical regions. The abdomen is distended and there is diffuse tenderness to palpation with rebound and guarding, worst in the epigastric region. There is hyperresonance to percussion in the epigastric region and absence of hepatic dullness in the right upper quadrant. Aspiration of the nasogastric tube reveals bloody contents. Focused assessment with sonography for trauma FAST shows free fluid in the pelvic region. Evaluation of the perisplenic and perihepatic regions is impossible due to the presence of free air. Aggressive intravenous fluid resuscitation is administered but fails to improve upon the patients hemodynamics. Which of the following is the next best step in management?? A: CT scan, B: Diagnostic peritoneal lavage DPL, C: Abdominal ultrasound, D: Emergency laparotomy, E: Emergency laparoscopy,  <response>: This is a clinical vignette describing a patient who has suffered abdominal trauma after being struck by a heavy object. The key findings are hypotension not responsive to fluid resuscitation, signs of peritonitis on abdominal exam, free fluid in the pelvis on FAST ultrasound, and evidence of free air on ultrasound preventing visualization of the liver and spleen. Based on these findings, this patient likely has intra-abdominal bleeding and hollow organ perforation causing peritonitis. The next best step in management would be an intervention to control the bleeding and repair any perforated organs, rather than further diagnostic tests.D: Emergency laparotomy 