Review Question - QID 216752

A 27-year-old man is brought to the emergency department by ambulance after experiencing a gunshot wound to the abdomen. In the emergency department, he opens his eyes to pain, is non-verbal, and withdraws from painful stimuli. A focused assessment with sonography in trauma (FAST) exam reveals free fluid in the abdominal cavity but is otherwise unremarkable. The patient’s temperature is 96.9°F (36.1°C), blood pressure is 90/50 mmHg, pulse is 120/min, and respirations are 20/min. The patient undergoes rapid sequence endotracheal intubation, is placed on a mechanical ventilator, and a massive blood transfusion protocol is initiated. Immediately afterwards, the patient’s blood pressure is 60/34 mmHg and pulse is 150/min and weak. His extremities are cold and clammy. Normal breath sounds are auscultated bilaterally. Which of the following is the most likely cause of this patient’s symptoms?