Differential Diagnosis for Shock Type
The patient's presentation suggests a shock state, and the differential diagnosis can be organized into the following categories:
- Single most likely diagnosis
- Hypovolaemic shock: The patient has a history of trauma, chest and abdominal bruises, and has been fully resuscitated, which suggests significant blood loss leading to hypovolemia. The low blood pressure (90/56) and tachycardia (P 116) support this diagnosis.
- Other Likely diagnoses
- Cardiac tamponade: The increased JVP and faint heart sounds are suggestive of cardiac tamponade, which can occur due to trauma causing a pericardial effusion. However, the presence of chest and abdominal bruises and the patient being fully resuscitated makes hypovolaemic shock more likely.
- Cardiogenic shock: Although less likely, cardiogenic shock cannot be ruled out entirely, especially if the patient has a pre-existing cardiac condition or if the trauma caused cardiac dysfunction. However, the absence of specific cardiac symptoms or signs makes this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Tension pneumothorax: Although not directly related to shock, a tension pneumothorax can cause hypotension, tachycardia, and decreased cardiac output, mimicking shock. It is a life-threatening condition that requires immediate diagnosis and treatment.
- Massive pulmonary embolism: A massive pulmonary embolism can cause hypotension, tachycardia, and decreased cardiac output, and can be a complication of trauma.
- Rare diagnoses
- Neurogenic shock: Although rare, neurogenic shock can occur due to spinal cord injury causing loss of sympathetic tone, leading to hypotension and bradycardia. However, the patient's tachycardia makes this diagnosis less likely.
- Anaphylactic shock: Anaphylactic shock is a rare but life-threatening condition that can cause hypotension, tachycardia, and decreased cardiac output. However, there is no clear history of an allergic reaction or anaphylaxis in this patient.