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Out of curiosity, what caused the crash? Was the patient driving? Makes me wonder if he had acute MI with subsequent wall rupture... have seen plenty of "trauma codes" that were actually medically precipitated.
That said with the pericardium blown out it sounds like it must have been some kind of shear injury from the trauma even in the absence of other signs of chest trauma.
Interesting case!
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Medicina Bona Locis Malis
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