48-year-old Amish female transferred via lifeflight after an auto vs. buggy accident.  The patient is intubated at the scene for a GCS 6.  Her vitals on arrival are as follows:  BP-84/50, HR 142, RR- 20 (bagged) and PO-100%.  On examination, she has multiple bruises noted on her torso and extremities.  Her pelvis is unstable and she has a closed right femur fracture.  After initial stabilization you perform a FAST exam.  The pericardial, perisplenic and pelvic windows were negative.  On the perihepatic window you note the following...

Take the Case