What type of shock is the most likely diagnosis in a patient with hypotension, tachycardia, tachypnea, hypothermia, and hypoxemia?

Hemorrhagic Shock

This patient is in hemorrhagic (hypovolemic) shock, characterized by the classic triad of hypotension (100/70 mmHg), tachycardia (120/min), and tachypnea (30/min), combined with hypothermia (35°C) and hypoxemia (90% oxygen saturation)—all indicating severe physiological derangement from volume loss. 1

Clinical Reasoning

The vital signs pattern definitively points to hemorrhagic shock through the following hemodynamic profile:

• Tachycardia (120/min) is the compensatory response to hypovolemia, as the body attempts to maintain cardiac output despite reduced intravascular volume 1
• Hypotension (100/70 mmHg) indicates failure of compensatory mechanisms and represents significant volume depletion 1
• Tachypnea (30/min) reflects metabolic acidosis from tissue hypoperfusion and anaerobic metabolism 2
• Hypothermia (35°C) is a critical sign of severe physiological derangement and is specifically associated with hemorrhagic shock requiring damage control surgery 1
• Hypoxemia (90% saturation) indicates inadequate oxygen delivery to tissues from reduced circulating blood volume 1

Why Not the Other Options?

Spinal (Neurogenic) Shock - Incorrect

• Neurogenic shock presents with bradycardia or normal heart rate, NOT tachycardia, due to loss of sympathetic tone 3
• The hemodynamic profile shows warm extremities and peripheral vasodilation, not the cool extremities expected with hypovolemia 3
• This patient's tachycardia of 120/min excludes neurogenic shock 3

Cardiogenic Shock - Incorrect

• Cardiogenic shock typically presents with tachycardia as compensation for reduced cardiac output, but would show elevated systemic vascular resistance and signs of pulmonary congestion 3, 4
• The clinical picture lacks evidence of elevated filling pressures, pulmonary edema, or jugular venous distension that characterize cardiogenic shock 5, 4
• Hypothermia is not a typical feature of cardiogenic shock 4

Anaphylactic Shock - Incorrect

• Anaphylactic (distributive) shock would present with peripheral vasodilation and warm extremities initially, not the hypothermia seen here 5
• Additional features like urticaria, angioedema, bronchospasm, or known allergen exposure would be expected but are absent 6
• The hypothermia and overall physiological derangement pattern better fits hemorrhagic shock 1

Critical Management Implications

Immediate aggressive fluid resuscitation with balanced crystalloids is the definitive therapy—vasopressors are NOT the primary treatment for hypovolemic shock. 5

• Isotonic crystalloid replacement in volumes equivalent to the patient's losses must begin immediately 1
• Vasopressors may only be used transiently in life-threatening hypotension while simultaneously achieving hemorrhage control and volume restoration 5
• The triad of acidosis, hypothermia, and coagulopathy indicates need for damage control surgery if a surgical source exists 1
• Monitor for signs of inadequate resuscitation: persistent tachycardia, oliguria, elevated lactate, and low arterial pH 1

Common Pitfall

The most dangerous error is initiating vasopressors as primary therapy without aggressive volume resuscitation—this worsens tissue perfusion and organ failure in hemorrhagic shock. 5