<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 45-year-old man is brought to the emergency department after a car accident with pain in the middle of his chest and some shortness of breath. He has sustained injuries to his right arm and leg. He did not lose consciousness. His temperature is 37C 98.6F, pulse is 110min, respirations are 18min, and blood pressure is 9060 mm Hg. He is alert and oriented to person, place, and time. Examination shows several injuries to the upper extremities and chest. There are jugular venous pulsations 10 cm above the sternal angle. Heart sounds are faint on cardiac examination. The lungs are clear to auscultation. An ECG is shown. Which of the following is the most appropriate next step in management?? A: Contrast esophagram with gastrografin, B: X-ray of the chest, C: CT scan of the brain, D: Contrast-enhanced CT angiography, E: Transthoracic echocardiography,  <response>: This is a clinical case scenario about a 45-year-old man who was in a car accident and is now presenting to the emergency department with chest pain, shortness of breath, and injuries to his right arm and leg. The key findings in the stem are chest pain, shortness of breath, normal temperature, tachycardia, hypotension, jugular venous distension, faint heart sounds, and a normal lung exam. Based on the clinical presentation, the main concern is a potential cardiac injury such as pericardial tamponade causing the patients symptoms. An esophagram, chest X-ray, and CT of the brain would not help diagnose the likely cardiac cause. A CT angiogram could identify vascular injuries but an echocardiogram is the best initial test to evaluate for pericardial effusion and cardiac tamponade.E: Transthoracic echocardiography 