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A 29-year-old male presents to the Emergency Department afte…
A 29-year-old male presents to the Emergency Department after experiencing a motor vehicle accident. The patient was the front seat passenger in a head on collision. The patient is responsive only to painful stimuli. His temperature is 99.5°F (37.5°C), blood pressure is 90/60 mmHg, pulse is 150/min, respirations are 17/min, and oxygen saturation is 95% on room air. The patient is started on IV fluids and is given blood products. A FAST exam reveals no signs of intra-abdominal bleeding. A chest radiograph is ordered and results are normal. A pelvic binder is placed and fluid and blood resuscitation is continued. Fifteen minutes later his temperature is 99.5°F (37.5°C), BP 110/70 mmHg, HR 100/min, RR 13/min, and oxygen saturation is 97% on room air. The patient is now able to respond to questions. The patient’s lab values are ordered and are as below: Serum:Na+: 137 mEq/LCl-: 102 mEq/LK+: 4.2 mEq/LHCO3-: 24 mEq/LBUN: 20 mg/dLGlucose: 110 mg/dLCreatinine: 1.1 mg/dLCa2+: 9.6 mg/dLAST: 12 U/LALT: 14 U/L Hemoglobin: 11 g/dLHematocrit: 30%Leukocyte count: 6,500 cells/mm^3 with normal differentialPlatelet count: 255,000/mm^3 The patient suddenly becomes short of breath. A chest radiograph is ordered (see image below). A FAST exam is repeated and is within normal limits. Repeat lab values are ordered as below: Hemoglobin: 13 g/dLHematocrit: 36%Leukocyte count: 6,000 cells/mm^3 with normal differentialPlatelet count: 250,000/mm^3 Which of the following best describes the most likely diagnosis?
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