ATLS | Shock

🚑 Trauma Shock & Thorax EmergenciesI) 🩸 Hemorrhagic (Hypovolemic) ShockPatho: Acute blood loss ↓preload → ↓SV/CO; early tachycardia + vasoconstriction; prolonged hypoperfusion → lactic acidosis; lethal triad = 🧊 hypothermia + 🩸 coagulopathy + acidosis. Fluids/Blood:Warm crystalloids (1 L adult, 20 mL/kg peds) → avoid excess; consider permissive hypotension.MTP: pRBCs/Plasma/Plts (warm). O neg for childbearing-age females; AB plasma if unknown type.TXA: within 3 hrs (bolus then 8-hr infuse).Calcium: guide by ionized Ca²⁺. No vasopressors first-line. Team: MD leads definitive bleed control (OR/angio); RN gets 2 large-bore IVs/IO, gives warmed fluids/blood, binder/pressure, tracks response; Lab preps products. Priority cues: Marked tachy + hypotension + narrow PP + ↓LOC (Class IV); cool, pale skin; ↓UO. Elderly may lack tachy on β-blockers—SBP 100 can be shock. RN priorities: Categorize response (rapid/transient/non-), direct pressure/binder, target UO ≥0.5 mL/kg/hr, warm patient & fluids to 39 °C, trend lactate/base deficit. High-yield: Don’t rely on SBP alone—watch pulse pressure; stop bleeding + balanced resus; vasopressors 🚫 initial.II) 🌪️ Tension Pneumothorax (Obstructive Shock)Patho: One-way valve air → ↑pleural pressure → lung collapse + mediastinal shift → ↓venous return. Management: Immediate decompression (needle/finger) → chest tube. Don’t wait for X-ray. Cues: Hypotension/CO drop, severe dyspnea/air hunger, absent unilateral breath sounds, hyperresonance, tracheal shift (late), JVD. RN: Set up decompression ASAP, then assist sterile tube; monitor hemodynamic rebound. Pearl: Think triad—hypotension + unilateral absent sounds + hyperresonance.III) ❤️ Cardiac Tamponade (Obstructive Shock)Patho: Blood in pericardium → impaired filling → ↓CO. Often penetrating trauma. Management: Definitive surgery; pericardiocentesis = temporizing. FAST to detect fluid. Cues: Beck’s triad = hypotension, muffled heart sounds, JVD; tachy; poor response to fluids. RN: Prep for OR, support FAST, note non-response to resus; educate that surgery removes pericardial blood.IV) 🧠 Neurogenic Shock (Distributive)Patho: Cervical/upper thoracic SCI → loss of sympathetic tone → vasodilation & hypotension; may coexist with bleeding. Isolated head injury doesn’t cause shock unless brainstem involved. Distinct cues: Hypotension without tachycardia, warm/dry skin (no vasoconstriction), normal/wide PP. Management: Treat as hypovolemic first; if unresponsive to fluids, pursue neurogenic cause with advanced monitoring. Maintain full C-spine precautions. High-yield: Key differential = low BP + no tachy + warm skin.