In which patient would early central venous pressure monitoring during fluid resuscitation be most useful?

Monitoring central venous pressure (CVP) during fluid resuscitation is particularly beneficial in patients who may have compromised cardiac function, as it provides insights into the preload of the heart and can guide fluid management. In the context of a patient with a severe cardiac contusion, there is a risk of myocardial dysfunction due to the traumatic injury to the heart. This condition can impair the heart's ability to effectively manage fluid volume.

By utilizing CVP monitoring, clinicians can assess the patient's volume status and cardiac filling pressures, which are crucial for making informed decisions about fluid administration. An elevated CVP may indicate the need for cautious fluid management to avoid volume overload, while a low CVP could demonstrate inadequate volume status requiring additional fluid resuscitation. Thus, in a patient with a severe cardiac contusion, early CVP monitoring is essential to optimize fluid resuscitation efforts and prevent potential complications arising from heart injury.

In contrast, the other patient scenarios do not involve acute cardiac compromise as central to their condition. While each may require careful management, they do not specifically necessitate the same level of precision in fluid resuscitation monitoring as seen in severe cardiac contusion cases.