<prompt> A 60-year-old man is hit by a pickup truck and brought to the emergency department with a blood pressure of 700 mm Hg. Peritoneal lavage showed no blood in the abdomen. The blood pressure is elevated to 85 systolic following the administration of 2 L of Ringers lactate. An x-ray showed a pelvic fracture. What is the next step in management?Exploratory laparotomy with packing of the pelvisCT scan of the pelvisExternal fixation of the pelvisOpen reduction and internal fixation ORIF of the pelvis  <response>: Early external fixation of the pelvis has been shown to reduce bleeding and mortality in patients in shock consequent to pelvic fractures. An unstable patient should not be sent for a CT scan. Selective angiography with embolization of the bleeding vessel may also be helpful in these patients. Laparotomy usually results in uncontrollable pelvic bleeding. 