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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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