Hemodynamics Case 3

A 65 year old man has been involved in a motor vehicle accident. He has come to the OR from the ER for fixation of his unstable pelvic fractures. His past medical history is not available. During the procedure he is persistently hypotensive despite ongoing fluid resuscitation and he is requiring high-dose vasopressor infusion. The surgeons feel confident that they have stabilized the fractures and that further blood loss should not be occurring. You decide to perform a TEE to try and diagnose the cause of his hypotension.

What is your diagnosis?

What treatment would you implement?