A 36 y.o. female presents after a rollover MVC.  On examination, she has a right wrist fracture, left femur fracture and left ankle fracture.  In addition, she has numerous thoracoabdominal bruises noted and a large scalp laceration that appears to have bleed a significant amount.  She remained hemodynamically stable until midway through her ED visit, when her blood pressure was noted to drop to 82/54 with a heart rate of 126.  As you begin fluid resuscitating the patient, you grab the ultrasound machine and perform a FAST exam.

Take the Case