Ultrasound for Critical Care Physicians: Hypotension After a MVA

A 25 year old woman was a restrained driver in a rollover motor vehicle accident (MVA) and suffered a C5-C6 fracture-dislocation with spinal cord injury. She was lucid and able to follow commands and could move her upper extremities but not her lower extremities. She was given approximately 6 liters of fluid but required vasopressors to maintain her blood pressure. Initial ECG revealed a normal sinus rhythm without significant ST changes (Figure 1).

Figure 1. Initial ECG.

Upon initial evaluation her blood pressure was low. Bedside ultrasound of the left anterior second intercostal space revealed a sliding lung sign and a 4 chamber view of her heart  was performed (Figure 2).

Figure 2. Four chamber view from the cardiac ultrasound.  

Which of the following is the most likely cause of her hypotension?

1. Blunt cardiac injury
2. Intravascular volume depletion
3. Neurogenic stunned myocardium
4. Pericardial tamponade
5. Pneumothorax

Reference as: Schmitz ED. Ultrasound for critical care physicians: hypotension after a MVA. Southwest J Pulm Crit Care. 2014;8(3):176-8. doi: http://dx.doi.org/10.13175/swjpcc023-14 PDF