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A 56 year old female is brought in by ambulance after a motor vehicle accident. She is awake and alert, but speaking in rapid short sentences. The patient states she was the restrained driver and now complains of pleuritic chest pain and difficulty breathing. Exam reveals, tachycardia, tachypnea, decreased breath sounds to her right lung fields. She has ecchymosis to the right anterior chest and a rapid survey reveals no other significant injuries or hemorrhage. Shortly after arriving to the emergency department, she loses consciousness and is now hypotensive.