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A 17-year-old female is shot medially to the right scapula. Vitals initially were blood pressure 90/P, pulse 120 bpm and respirations 32. Paramedics administered 2 liters of normal saline via 2 lines and high flow oxygen by mask. In the emergency department, the patient is diaphoretic and agitated. Heart sounds cannot be heard secondary to environmental noise. Neck veins are flat. Her respiratory status and blood pressure worsen over several minutes, but she is still oriented x 3 and conscious. What is the next step in management?

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