He survives and makes it to the local emergency room, awake and apparently in pretty good shape, but then turns out to have suffered a serious heart injury. His aorta, the main trunk through which the heart pumps blood into the arteries, is ruptured, or partially torn away from the heart. Called traumatic aortic disruption, this is a common cause of death in automobile collisions and other accidents. As serious and as common as it is, however, traumatic aortic disruption can be surprisingly difficult for doctors or emergency medical staff to detect. The steering wheel was broken and the windshield smashed.
Bystanders report that the patient was unconscious for a few minutes after the accident.
However, he is now awake but confused and agitated. The patient has slightly elevated blood pressure, facial cuts and blood in both nostrils. Breathing okay, lungs are clear. The patient has been strapped to a board and put in a cervical collar to protect his spine from further injury, and has been given an oxygen mask and IV saline. We will be in the department in two minutes.