Review Question - QID 214187

A 50-year-old man with a past medical history of hypertension presents to the emergency department after being struck by a car while riding his bicycle. The patient was obtunded and thus intubated in the field. On arrival, his temperature is 97.5°F (36.4°C), blood pressure is 120/82 mmHg, pulse is 100/min, respirations are 15/min, and oxygen saturation is 98% on a FiO2 of 25%. An initial focused assessment with sonography in trauma (FAST) exam is unremarkable and demonstrates normal cardiac contractility and lung sliding. The primary and secondary survey are noticeable for a head laceration, bruising over the scalp, and a deep yet hemostatic laceration over the left lower extremity with debris. The patient becomes agitated and attempts to self-extubate. He is subsequently given IV fluids, blood products, hypertonic saline, propofol, cefepime, and vancomycin. Subsequently, his temperature is 97.5°F (36.4°C), blood pressure is 100/62 mmHg, pulse is 120/min, respirations are 15/min, and oxygen saturation is 99% on a FiO2 of 25%. A repeat FAST is notable only for global decreased cardiac contractility with no other findings. An ECG demonstrates a right bundle branch without significant ST segment changes from a previous ECG. Which of the following is the most likely cause of this patient's hypotension?