Short Answer 
The assessment of a trauma patient should begin by checking vital signs to identify potential complications like hypocalcemia, which may arise from citrate binding during blood transfusions. The main intervention is administering calcium gluconate to address the calcium deficit, focusing on monitoring the patient’s response to treatment.
Step 1: Assess the Trauma Patient
Begin by thoroughly assessing the trauma patient’s vital signs and presenting symptoms. Key indicators to focus on include:
- Blood pressure, which is currently at 104/66 mmHg.
- Heart rate, elevated at 112 beats/minute.
- Presence of muscle tremors and ventricular bigeminy, suggesting possible electrolyte imbalances.
This assessment will aid in diagnosing potential complications resulting from significant fluid resuscitation and blood transfusions, particularly hypocalcemia.
Step 2: Identify the Electrolyte Imbalance
Recognize that the patient’s symptoms likely result from hypocalcemia, which can occur due to citrate binding calcium during massive transfusions. Pay attention to the significance of:
- Understanding the role of citrate in blood products and its effect on calcium levels.
- Realizing that citrate toxicity is a common complication in patients receiving large amounts of blood products.
- Linking the cardiovascular instability and muscle tremors to this electrolyte disturbance.
Step 3: Administer Appropriate Interventions
Prepare to administer calcium gluconate as the primary intervention to address the identified calcium deficit. Consider the following actions:
- Prioritize calcium replacement over other solutions like whole blood or magnesium sulfate.
- Understand that while cryoprecipitate may help with fibrinogen levels, it will not correct hypocalcemia.
- Monitor the patient closely after administration for any improvements or further complications.
Calcium gluconate will counteract the effects of citrate toxicity and stabilize the patient’s condition effectively.