A 57-year-old male in a high-speed crash has forehead laceration and abdominal distension with pale, cool skin. BP 80/50, P 120, R 20. What should you suspect?

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In blunt, high‑speed trauma, a rapid collapse in blood pressure with abdominal distension and pale, cool skin signals internal bleeding into the abdomen, causing hemorrhagic (hypovolemic) shock. The liver, being large and highly vascular, is a common source of significant bleeding after blunt trauma in adults. A lacerated liver would readily produce the dramatic hemorrhage needed to drop blood pressure and raise the heart rate, along with abdominal distension from blood accumulating in the peritoneal cavity. While splenic injury can also cause intra‑abdominal bleeding, the liver’s size and blood supply make it the most likely source in this scenario. Bladder rupture or spinal fracture don’t fit the pattern of rapid intraperitoneal bleeding and shock seen here.