SHock in TraUma

Some joker on Twitter called Chrimes took this at Aspen, Colorado

It is an oft quoted maxim of trauma resuscitation that shock is haemorrhagic until proven otherwise. Certainly for penetrating trauma this is all often 100% accurate but for blunt trauma it becomes less and less a reliable rule.

Cardiac causes of shock in trauma? Why yes dear reader. Classically the car driver who suffers a myocardial infarction then crashes the car. Albeit yes he/she may be in shock due to a smashed femur but what of their cardiogenic shock from the acute anterior MI? Would pouring litres of salty pasta fluid into their compromised circulation be prudent? Perhaps not.

But in blunt trauma why couldnt the heart be damaged as well? Myocardial contusion does occur. And folks with pre-existing cardiomyopathy do suffer trauma too! So maybe for that next trauma patient you need to consider these cardiac causes of shock as well. If bleeding is obvious of course then that must be stopped and circulating volume replaced appropriately

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