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Original Question

A 32-year-old male presents to the emergency department by ambulance after a high-speed motorcycle rollover accident. The patient was wearing a helmet and was thrown 20 ft from the motorcycle. A cervical collar was placed at the scene. Vital signs include temperature of 98.6°F, pulse of 132 beats/min, respiratory rate of 20 breaths/min, blood pressure of 82/54 mmg and oxygen saturation of 85% on 100% oxygen by nonrebreather mask. Absent breath sounds are noted on the left. A needle decompression is performed, followed by placement offa chest tube. Because of obtundation with sonorous respirations, he is intubated and placed on a ventilator. Cardiac examination demonstrates normal heart sounds with rapid rate, regular rhythm and no murmurs. Ecchymosis is noted over the left chest wall and left upper and lower quadrants of the abdomen. Crepitus is noted over the lower ribs on the left side, and the abdomen is distended. The pelvis is stable. Warm intravenous fluids are administered, followed by transfusion with type O packed red blood cells. The patient’s vital signs remain unchanged after these interventions. Focused Assessment with Sonography for Trauma (FAST) scan is positive for free fluid in the abdomen with no blood identified in the pericardium. Injury to which of the following organs is the most likely cause of this patient’s hypotension? (A) Bladder (B) Liver (C) Pancreas (D) Small bowel (E) Spleen

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