2nd August 2023

An 82-year-old man is admitted after being involved in a motor vehicle collision resulting in chest and abdominal injuries

An 82-year-old man is admitted after being involved in a motor vehicle collision resulting in chest and abdominal injuries, including a splenic rupture. He undergoes surgery and returns to ITU. After eight hours, he becomes hypotensive and febrile, requiring intubation for respiratory distress.

His observations at the time are RR 45, HR 134bpm and irregularly irregular, BP 75/45, and temperature 38.9.

During his operation, he is given intra-operative antibiotics. He has an estimated blood loss of 1.5L, which is replaced with 2 units of blood, 2 units of FFP and 4 litres of IV fluid. His post op bloods show a Hb of 125, Cr 110, CRP 140, WCC 21.4 with neutrophils of 15.

Which of the following is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.