Cardiogenic Shock

• Cardiac arrhythmias, myocardial damage
• Pericardial tamponade
  • Diagnosis: distended neck veins, hypotension, muffled heart sounds (Beck triad)
  • Treatment: pericardiocentesis through subxiphoid approach

Neurogenic Shock

• This occurs in patients with a thoracic level spinal cord injury in which sympathetic disruption results in an inability to maintain vascular tone.
  • Diagnosis: hypotension without tachycardia or vasoconstriction. Consider in a head- or spinal cord–injured patient who does not respond to fluid resuscitation.
  • Treatment: volume restoration followed by vasoactive drugs (Beware of fluid overload.)

Septic Shock

• Consider in patients with gas gangrene, missed open injuries, and contaminated wounds closed primarily.
  • Diagnosis: hypotension accompanied by fever, tachycardia, cool skin, and multiorgan failure. This occurs in the early-to-late phases but not in the acute presentation.
  • Treatment: fluid balance, vasoactive drugs, and antibiotics

Hemorrhagic Shock

• More than 90% of patients are in acute shock after trauma.
• Consider in patients with large open wounds, active bleeding, pelvic and/or femoral fractures, and abdominal or thoracic trauma.
  • Diagnosis: hypotension, tachycardia. In the absence of open hemorrhage, bleeding into voluminous spaces (chest, abdomen, pelvis, thigh) must be ruled out. This may require diagnostic peritoneal lavage, focused assessment with sonography for trauma (FAST) angiography, computed tomography (CT), magnetic resonance imaging (MRI), or other techniques as dictated by the patient presentation.
  • Treatment: aggressive fluid resuscitation, blood replacement, angiographic embolization, operative intervention, fracture stabilization, and other techniques as dictated by the source of hemorrhage