Associated with !Syncope
Worried about !Shock and ECFVD - Volume depletion
| Etiology | Causes/Risk Factors | Presentation / Investigations | Management |
|---|---|---|---|
| Major Hemorrhage ( ‣) | Inadequate hemostasis, ‣ (e.g. liver disease) | ‣ , low ‣, signs of ‣ ; blood +++ |
↑ ‣ | ‣, ‣, packing, source control | | !Sepsis | Post-op infection (‣ , ‣ , ‣ ), ‣ | ‣
↑ ‣, ‣ ; ‣, ‣) | Broad spectrum Abx (‣ + ‣), ‣, source control | | Adrenal Insufficiency | ↓Adrenal Insufficiency (Addison’s) , chronic Oral Corticosteroid (OCS) (COPD, RA), suppressed HPA axis | Hypotension refractory to fluids, often clinical diagnosis based on history
‣ (↓ Na⁺, ↑ K⁺); | IV ‣ | | Cardiac Causes | ‣/ ‣ / ‣ (e.g. AFib with RVR), missed cardiac meds | ‣ , ‣ , ‣ ‣ ,
abnormal ‣ , ↑ ‣, ‣, or CXR | Based on cause |
SHOCK-T
| Condition | Mechanism | Presentation | Investigation |
|---|---|---|---|
| S - Spinal cord injury or Sepsis | Spinal injury above T6 | Autonomic Dysreflexia: SNS below → Hypertension; PNS above → Bradycardia, low JVP, warm extremities | C-spine XR/CT: fracture, displacement, disc herniation |
| H - Hypovolemia (bleeding, pelvic/long bone fracture) | Decreased intravascular volume from bleeding | General: Tachycardia, decreased pulse pressure, cool pale extremities, low JVP, absent distal pulses; Late: Metabolic acidosis, ↑ lactate | ABG, hemoglobin, imaging for bleeding |
| External bleeding | See blood | Direct observation | |
| Intra-peritoneal bleeding | Abdominal distention, tenderness, percussion dullness (PE unreliable) | FAST scan, CT (solid organ injury, contrast extravasation, free fluid) | |
| Retroperitoneal bleeding | — | CT (injury to retroperitoneal organs/pelvis); FAST not helpful | |
| Pelvic bleeding | — | CT, angiogram (preferred if available) | |
| Leg/long bone fracture | Compartment syndrome, pain | Look for long bone fracture features | |
| Hemothorax | ↓ Air entry, dullness on auscultation | CXR: haziness or hematoma; sitting CXR shows fluid line (rare in trauma pts) | |
| O - Obstructive (fat/air thrombus, TPTX) | Tension pneumothorax | Tachycardia, hypoxemia, cool pale extremities, hyperresonance, ↑ JVP | CXR: mediastinal shift; US: tension pneumothorax signs |
| Cardiac tamponade | Tachycardia, ↑ JVP, muffled heart sounds | Echo/CT/US: pericardial fluid | |
| C - Cardiogenic (myocardial, endocardial) | Myocardial infarction | — | Troponins, ECG, CXR |
| Myocardial contusion | Sternal bruising/fracture, chest pain | ECG (arrhythmias), echo abnormalities | |
| Endocardial trauma (valve/septum rupture) | Acute MI-like presentation | ECG, troponins, echo | |
| K - Anaphylaxis | Immune-mediated systemic reaction | Tachycardia, warm extremities, tongue swelling, stridor, hives, ≥2 systems | Clinical diagnosis |
| T - Transfusion reaction | Immune reaction to transfused product | Signs during/after transfusion | Consider in trauma patients receiving blood; labs vary by reaction type |