Editing Trauma - circulation (section)

== '''Types of shock seen in trauma (see separate topic 'Shock' for pathophysiology)''' ==

* '''Haemorrhagic shock'''
* '''Cardiogenic'''
** Aetiology - blunt cardiac injury, tamponade, air embolus, MI
** Suspect when mechanism of injury to thorax involves rapid deceleration
** Put continuous ECG monitoring on thoracic trauma patients
** Tamponade - Beck's triad - muffled heart sounds, distended neck veins, hypotension (also tachycardia and minimal response to IVF)
*** Need to think about PTX if these signs are present too
* '''Tension PTX'''
** Shift of mediastinum to opposite side (AWAY)
** Impaired venous return and fall in cardiac output
** Acute respiratory distress, subcutaneous emphysema, absent unilateral breath sounds, hyperresonance to percussion, tracheal shift
** Needle decompression followed by chest tube
* '''Tamponade'''
* '''Neurogenic shock'''
** Isolated intracranial injuries do not cause shock
** Hypotension without tachycardia or cutaneous vasoconstriction. No narrowed pulse pressure.
** Look for thoracic/lower cervical trauma
** Won't respond to IVF
* '''Spinal shock'''


''Goals of treatment: to control haemorrhage and restore adequate circulating volume''

Primary and secondary survey should pick it up

* Assume any patient who is cool to the touch and tachycardic to be in shock
* VBG - look at base deficit and lactate levels rather than Hb or haematocrit
* Evaluate pulse pressure rather than SBP in early shock