Your patient is a 24-year-old male who has been an in-patient in a rehabilitation hospital following surgical fixation of a fractured pelvis. Staff reports sudden development of hypotension and severe respiratory distress about 30 minutes ago. There is no other significant history. Physical exam findings include cold, diaphoretic skin with peripheral cyanosis; jugular venous distension; clear

breath sounds bilaterally; and vitals as follows: HR = 134, BP = 74/50, RR = 28, SaO2 = 84%. Which of the following is most likely?

A) Spontaneous tension pneumothorax
B) Pulmonary embolism
C) Myocardial infarction
D) Idiopathic congestive heart failure

B