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A patient is involved in a motor vehicle collision and suffers multiorgan trauma. He is brought to the emergency department by emergency medical services and found to be hypotensive and bradycardic. He is disoriented and confused. He has a Glasgow coma scale score of 9. His abdomen is non-distended, legs warm, and pulses thready. His central venous pressure is 9 mmHg, heart rate 42 beats/min, and blood pressure 80/40 mmHg. What is the most likely cause of his shock state?

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