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HardRural & Remote MedicineRural trauma haemorrhage managementau-amcau-acem

A 48-year-old man is brought to a small rural ED after a high-speed motor vehicle collision. He is conscious but pale and clammy. BP is 80/50 mmHg, pulse 130 bpm. Pelvic tenderness is noted and FAST ultrasound shows free fluid. There is limited blood on site and retrieval to a tertiary centre will take 90 minutes. What is the most appropriate immediate management?

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