Did you try verifying your game cache integrity, removing all mods (including the Script Extender if you have it), and resetting all preferences/ini tweaks to default values? It's hard to verify if the problem is caused by the patch itself unless we know you have a clean game install.
I removed all mods, I do not use script extender, I never touched the ini's, I haven't tweaked any of my options (all are set to ultra/maxed). The game was running fine yesterday, as soon as I installed the patch today it won't open.
This is the Report.wer on the crash:
Version=1
EventType=APPCRASH
EventTime=129338475273317793
ReportType=2
Consent=1
UploadTime=129338475273629794
ReportIdentifier=b01a5462-ec9b-11df-a5c2-001fbc095572
IntegratorReportIdentifier=b01a5461-ec9b-11df-a5c2-001fbc095572
WOW64=1
Response.BucketId=2177929228
Response.BucketTable=1
Response.type=4
Sig[0].Name=Application Name
Sig[0].Value=http://forums.bethsoft.com/index.php?/topic/1139442-111-patch-killed-my-fonv/FalloutNV.exe
Sig[1].Name=Application Version
Sig[1].Value=http://forums.bethsoft.com/index.php?/topic/1139442-111-patch-killed-my-fonv/1.2.0.285
Sig[2].Name=Application Timestamp
Sig[2].Value=http://forums.bethsoft.com/index.php?/topic/1139442-111-patch-killed-my-fonv/4cd9d70b
Sig[3].Name=Fault Module Name
Sig[3].Value=http://forums.bethsoft.com/index.php?/topic/1139442-111-patch-killed-my-fonv/FalloutNV.exe
Sig[4].Name=Fault Module Version
Sig[4].Value=http://forums.bethsoft.com/index.php?/topic/1139442-111-patch-killed-my-fonv/1.2.0.285
Sig[5].Name=Fault Module Timestamp
Sig[5].Value=http://forums.bethsoft.com/index.php?/topic/1139442-111-patch-killed-my-fonv/4cd9d70b
Sig[6].Name=Exception Code
Sig[6].Value=http://forums.bethsoft.com/index.php?/topic/1139442-111-patch-killed-my-fonv/c0000005
Sig[7].Name=Exception Offset
Sig[7].Value=http://forums.bethsoft.com/index.php?/topic/1139442-111-patch-killed-my-fonv/00ac12ce
DynamicSig[1].Name=OS Version
DynamicSig[1].Value=http://forums.bethsoft.com/index.php?/topic/1139442-111-patch-killed-my-fonv/6.1.7600.2.0.0.768.3
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DynamicSig[25].Value=http://forums.bethsoft.com/index.php?/topic/1139442-111-patch-killed-my-fonv/0a9e372d3b4ad19135b953a78882e789
UI[2]=c:\program files (x86)\steam\steamapps\common\fallout new vegas\FalloutNV.exe
UI[3]=FalloutNV has stopped working
UI[4]=Windows can check online for a solution to the problem.
UI[5]=Check online for a solution and close the program
UI[6]=Check online for a solution later and close the program
UI[7]=Close the program
LoadedModule[0]=c:\program files (x86)\steam\steamapps\common\fallout new vegas\FalloutNV.exe
LoadedModule[1]=C:\Windows\SysWOW64\ntdll.dll
LoadedModule[2]=C:\Windows\syswow64\kernel32.dll
LoadedModule[3]=C:\Windows\syswow64\KERNELBASE.dll
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LoadedModule[6]=C:\Windows\syswow64\msvcrt.dll
LoadedModule[7]=C:\Windows\SysWOW64\sechost.dll
LoadedModule[8]=C:\Windows\syswow64\RPCRT4.dll
LoadedModule[9]=C:\Windows\syswow64\SspiCli.dll
LoadedModule[10]=C:\Windows\syswow64\CRYPTBASE.dll
LoadedModule[11]=C:\Windows\syswow64\GDI32.dll
LoadedModule[12]=C:\Windows\syswow64\USER32.dll
LoadedModule[13]=C:\Windows\syswow64\LPK.dll
LoadedModule[14]=C:\Windows\syswow64\USP10.dll
LoadedModule[15]=C:\Windows\system32\d3d9.dll
LoadedModule[16]=C:\Windows\system32\VERSION.dll
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LoadedModule[19]=C:\Windows\system32\XINPUT1_3.dll
LoadedModule[20]=C:\Windows\syswow64\SETUPAPI.dll
LoadedModule[21]=C:\Windows\syswow64\CFGMGR32.dll
LoadedModule[22]=C:\Windows\syswow64\OLEAUT32.dll
LoadedModule[23]=C:\Windows\syswow64\ole32.dll
LoadedModule[24]=C:\Windows\syswow64\DEVOBJ.dll
LoadedModule[25]=C:\Windows\syswow64\SHELL32.dll
LoadedModule[26]=C:\Windows\syswow64\SHLWAPI.dll
LoadedModule[27]=c:\program files (x86)\steam\steamapps\common\fallout new vegas\steam_api.dll
LoadedModule[28]=C:\Windows\system32\WSOCK32.dll
LoadedModule[29]=C:\Windows\syswow64\WS2_32.dll
LoadedModule[30]=C:\Windows\syswow64\NSI.dll
LoadedModule[31]=C:\Windows\system32\d3dx9_38.dll
LoadedModule[32]=C:\Windows\system32\DINPUT8.dll
LoadedModule[33]=C:\Windows\system32\WINMM.dll
LoadedModule[34]=C:\Windows\system32\DSOUND.dll
LoadedModule[35]=C:\Windows\system32\POWRPROF.dll
LoadedModule[36]=c:\program files (x86)\steam\steamapps\common\fallout new vegas\binkw32.dll
LoadedModule[37]=c:\program files (x86)\steam\steamapps\common\fallout new vegas\libvorbisfile.dll
LoadedModule[38]=c:\program files (x86)\steam\steamapps\common\fallout new vegas\libvorbis.dll
LoadedModule[39]=C:\Windows\system32\apphelp.dll
LoadedModule[40]=C:\Windows\AppPatch\AcLayers.DLL
LoadedModule[41]=C:\Windows\system32\USERENV.dll
LoadedModule[42]=C:\Windows\system32\profapi.dll
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LoadedModule[48]=C:\Windows\system32\CRYPTSP.dll
LoadedModule[49]=C:\Windows\system32\rsaenh.dll
LoadedModule[50]=C:\Windows\system32\uxtheme.dll
LoadedModule[51]=C:\program files (x86)\steam\steamclient.dll
LoadedModule[52]=C:\Windows\syswow64\CRYPT32.dll
LoadedModule[53]=C:\Windows\syswow64\MSASN1.dll
LoadedModule[54]=C:\Windows\syswow64\imagehlp.dll
LoadedModule[55]=C:\program files (x86)\steam\tier0_s.dll
LoadedModule[56]=C:\program files (x86)\steam\vstdlib_s.dll
LoadedModule[57]=C:\Windows\system32\iphlpapi.dll
LoadedModule[58]=C:\Windows\system32\WINNSI.DLL
LoadedModule[59]=C:\Windows\system32\Secur32.dll
LoadedModule[60]=C:\Windows\syswow64\psapi.dll
LoadedModule[61]=C:\program files (x86)\steam\steam.dll
LoadedModule[62]=c:\program files (x86)\steam\DbgHelp.dll
LoadedModule[63]=C:\program files (x86)\steam\CSERHelper.dll
LoadedModule[64]=C:\Windows\system32\atiu9pag.dll
State[0].Key=Transport.DoneStage1
State[0].Value=http://forums.bethsoft.com/index.php?/topic/1139442-111-patch-killed-my-fonv/1
FriendlyEventName=Stopped working
ConsentKey=APPCRASH
AppName=FalloutNV
AppPath=c:\program files (x86)\steam\steamapps\common\fallout new vegas\FalloutNV.exe