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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 with bradycardia. He is disoriented and confused. He has a Glasgow coma scale score of 9. His abdomen is non-distended, his legs are warm, and his pulses thready. His central venous pressure is 9 mmHg, heart rate is 42 beats/min, and blood pressure is 80/40 mmHg. What is the most likely cause of his shock state?

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