Etiology of shock in blunt trauma.

Patients who have suffered blunt trauma and present in shock of uncertain cause represent a problem frequently encountered by emergency physicians. A retrospective review of the charts of 879 patients who had suffered blunt trauma and presented to a regional trauma unit over a 44-month period revealed that 154 of the patients had presented to either a hospital or the trauma unit in shock. The most common causes of shock when a single source of hemorrhage was identified were, in order of decreasing frequency, intraperitoneal hemorrhage, pelvic or other musculoskeletal fractures, thoracic hemorrhage, severe head injury and spinal cord injury. Severe head injuries accounted for only 8% of the single-source cases and contributed to shock in only seven of the remaining cases.