An 87-year-old female nursing home resident presents to the ED hypotensive after a fall.  The patient has a history of organic brain syndrome, a fib on coumadin, hypertension, coronary artery disease, hypothyroidism and gout.  The patient is nonverbal.  Her vitals signs are as follows: BP 62/40, HR 108, RR 26 and PO of 95%.  Her physical examination reveals multiple abrasions and a large ecchymotic region in the left flank and left lateral thorax.  You perform a FAST exam to evaluate her for the hypotension.  Her pericardial window reveals no evidence of pericardal effusion or tamponade.  Her perihepatic and pelvic windows were negative.  You note the following on her perisplenic window...

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