Severe Injury After Being Struck by a Car

A 59-year-old man was struck by a car while walking. He was initially evaluated at another facility, intubated, resuscitated, and stabilized, then transferred to your facility. He is believed to have a severe head injury and possibly other internal injuries. The man is unresponsive on arrival at your facility. No medical history is available. His vital signs are stable, with a blood pressure of 113/74 mm Hg; heart rate, 101 beats/min; and respiratory rate, 14 breaths/min. Initial Glasgow Coma Scale score is reported as a 3T. It is unclear whether the patient has recently received any sedation. As you are reviewing the results of testing conducted at both your facility and the facility to which the patient was originally taken, you see a portable pelvic radiograph (shown). What is your impression?