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A Patient with Multisystem Trauma Has Been in the ICU

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A patient with multisystem trauma has been in the ICU for 6 days after sustaining a closed head injury, a right-sided pneumothorax, right rib fractures, a grade IV liver laceration, a pancreatic contusion, and a right acetabular fracture.The patient is still intubated and mechanically ventilated and has a chest tube, Foley catheter, and two abdominal drains.The patient's hemodynamic assessment reveals the following values: BP, 94/66 mm Hg; HR, 118 beats/min; T, 38.7° C; CVP, 5 cm H2O; wedge pressure, 6 mm Hg; cardiac index, 6.1; and systemic vascular resistance, 450 dynes/sec.What is the most likely cause of this hemodynamic picture?

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