Review Question - QID 108646

A 54-year-old man is brought to the emergency department by ambulance after a high-speed motor vehicle collision. His medical history and medications are unknown. On arrival in the trauma bay, his temperature is 98.6°F (37.0°C), blood pressure is 110/70 mmHg, pulse is 100/min, and respirations are 20/min. His Glasgow Coma Score (GCS) is 13 (eye opening 3, verbal response 5, and motor response 5). Physical exam is notable for a rapid and thready pulse, and a rigid and distended abdomen with positive rebound tenderness. A focused assessment with sonography for trauma (FAST) exam reveals a large hypoechoic stripe in the hepatorenal recess. The patient is given a 1L bolus of normal saline. His mental status rapidly deteriorates and he becomes unresponsive. His pulse is 149/min and blood pressure is 70/40 mmHg. The patient is started on bolus fluids and pRBC, but blood pressure remains 77/42 mmHg. He is started on new infusion and a subsequent set of vital signs shows a pulse of 80/minute and blood pressure of 120/80 mmHg. While the patient is being taken to the operating room, he develops pain in all 4 distal extremities. His digits appear blue and are cool to the touch. Which medication was most likely responsible for this complication?