Short Answer 
The first step in managing a trauma patient involves assessing their vital signs to detect cardiovascular instability and potential hypocalcemia. The crucial intervention is administering calcium gluconate to counter citrate toxicity from blood transfusions, followed by close monitoring to ensure the patient’s condition improves and stabilizes.
Step 1: Assess the Trauma Patient’s Condition
The first step is to carefully evaluate the trauma patient’s signs and symptoms. An assessment of vital signs is crucial, as the patient is showing indications of cardiovascular instability, including a blood pressure of 104/66 mmHg and a heart rate of 112 beats/minute. Additionally, the patient’s muscle tremors and irregular heartbeat, specifically intermittent ventricular bigeminy, suggest underlying issues such as hypocalcemia, typically arising from citrate binding calcium during large-scale blood transfusions.
Step 2: Identify the Appropriate Intervention
Based on the assessment, the nurse should prepare to administer the correct treatment urgently. The primary intervention required is calcium gluconate, which addresses the potential citrate toxicity from the blood transfusion. This medication is vital for replenishing the calcium levels that could be depleted due to the massive transfusion. Other options, such as whole blood or magnesium sulfate, are not immediately necessary as they do not effectively target the calcium imbalances.
Step 3: Implement and Monitor Treatment
Administer the calcium gluconate according to the treatment plan and monitor the patient’s response closely. Continuous observation is critical to ensure that the heart rate stabilizes and signs of hypocalcemia diminish. Additionally, keep in mind that while transfusions can cause various complications, timely intervention with the right treatment will significantly enhance the patient’s recovery and overall stability.