Hemodynamic instability in trauma patients is most often associated with hemorrhagic shock, however, there is an entity known as brain injury associated shock (BIAS). BIAS is thought to be associated with catecholamine surges secondary to brain injury. BIAS is found in both isolated head injury pts as well as multi-trauma patients. Studies have identified BIAS in 13% of adult trauma patients and up to 40% of pediatric major trauma patients.
We know hypotension in brain injury worsens outcome. We should assume hemorrhagic etiology until we prove otherwise. Once we suspect BIAS and have excluded hemorrhagic etiology our strategy should switch to blood pressure support using non-blood product management.
References
Partyka C, Alexiou A, Williams J, Bliss J, Miller M, Ferguson I. Brain Injury Associated Shock: An Under-Recognized and Challenging Prehospital Phenomenon. Prehospital and Disaster Medicine. Published online 2024:1-6. doi:10.1017/S1049023X24000359
