<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 27-year-old soldier stationed in Libya sustains a shrapnel injury during an attack, causing a traumatic above-elbow amputation. The resulting arterial bleed is managed with a tourniquet prior to transport to the military treatment facility. On arrival, he is alert and oriented to person, place, and time. His armor and clothing are removed. His pulse is 145min, respirations are 28min, and blood pressure is 9552 mm Hg. Pulmonary examination shows symmetric chest rise. The lungs are clear to auscultation. Abdominal examination shows no abnormalities. There are multiple shrapnel wounds over the upper and lower extremities. A tourniquet is in place around the right upper extremity; the right proximal forearm has been amputated. One large-bore intravenous catheter is placed in the left antecubital fossa. Despite multiple attempts, medical staff is unable to establish additional intravenous access. Which of the following is the most appropriate next step in management?? A: Irrigate the shrapnel wounds, B: Establish central venous access, C: Replace the tourniquet with a pressure dressing, D: Establish intraosseous access, E: Perform endotracheal intubation,  <response>: This is a trauma case involving a soldier who sustained a traumatic above-elbow amputation from a shrapnel injury. The key points are:- Massive hemorrhage from amputation initially controlled with a tourniquet - Signs of hypovolemic shock on arrival tachycardia, hypotension- Only one peripheral IV established so far- Unable to obtain additional IV access despite multiple attemptsThe priority is to manage the hypovolemic shock and provide volume resuscitation. Since additional peripheral IV access cannot be obtained, more definitive vascular access is needed urgently. Irrigating wounds, replacing the tourniquet, intubating, and establishing central access are not the next best steps. Intraosseous access allows rapid vascular access for fluid and blood product resuscitation in this trauma patient.D: Establish intraosseous access 