PLE-8323

A 32-year-old man is brought to the emergency department 30 minutes after being involved in a motor vehicle collision. He was the restrained driver. On arrival, he is alert and has shortness of breath. His blood pressure is 80/50 mm Hg, pulse is 130/min, and respirations are 30/min. Examination shows jugular venous distention and abrasions over the left hemithorax. The trachea is deviated to the right. Breath sounds are absent on the left. What is the most likely cause of the hypotension?