Correct!
2. CT scan of the chest, abdomen, and pelvis with contrast
Although the high FiO2 with relatively low pO2 is concerning, the major life-threatening threat is hemorrhage. In the setting of a motor vehicle accident with major blunt trauma this might suggest intra-abdominal hemorrhage such as a lacerated spleen or intra-thoracic trauma such as aortic rupture. Although there is no widening of the mediastinum on the chest x-ray (> 6 cm upright, > 8 cm supine), an aortic rupture is still possible. The quickest diagnostic procedure is chest and abdominal CT scans in hemodynamically stable patients (2). She was judged sufficiently stable to undergo CT scanning. The chest CT revealed no aortic injury but the abdominal CT scan revealed a Grade V splenic injury (the worst injury). A CT scan of the head and spine performed at the same time showed no abnormalities. She was taken to the operating room and a splenectomy was performed along with her humeral fracture being reduced and set.
She returns to the intensive care unit post-operatively still on an FiO2 of 100% with 20 cm H2O PEEP with the following ABGs:
Which of the following should be done next? (Click on the correct answer to proceed to the fifth of six panels)