Answer 3

The first view is a ME 4-chamber view, and the interatrial septum is seen to be very mobile. It is moving more than normal in both directions (ie towards the RA and the LA). This could be consistent with either hypovolemia or an aneurysmal interatrial septum. The second view is a TG SAX view of the LV at the mid-papillary level. There is a small end-diastolic area, and at end-systole the LV cavity is almost obliterated, so this would be consistent with hypovolemia.

The patient needs ongoing fluid resuscitation, and the cause of this ongoing loss needs to be addressed. Discussion with the surgeon about possible vascular injury in the pelvic area, and consideration of other possible injuries that have not been thus diagnosed must occur. Further investigation and management should proceed dependent on review of the initial trauma survey, and clinical suspicion in the context of the mechanism of injury.