Review Question - QID 210851

A 45-year-old man presents to the emergency department after being stabbed 12 times in various parts of his body. Paramedics report extensive blood loss at the scene where he was found. Due to his Glasgow Coma Scale score of 3, an endotracheal airway and large-bore access are secured prior to arrival. He is aggressively resuscitated with a massive transfusion protocol as the operating room is prepared for an exploratory laparotomy. An arterial line and central access are obtained. His temperature is 95°F (35°C), blood pressure is 50/40 mmHg, and pulse is 80/min, and respirations are controlled at 20/min on lung-protective volume control. After a 6:6:1 ratio of red blood cells, plasma, and platelets and the use of continuous phenylephrine infusion, the patient's vital signs remain the same. The surgical team reports no active blood loss. A stat ScvO2 results as 39% with a SaO2 of 100% on 100% oxygen. His extremities remain cold despite having the ambient room temperature increased to 80°F (26.7°C). What is the most likely cause of his presentation?