These patients should be treated initially with lactated Ringer's until the diagnosis is confirmed. After volume restoration, the treatment consists of alpha agonists - phenylephrine and neosynephrine. There is no need for inotropic support with drugs such as dopamine or epinephrine. Septic shock is also rare with acute trauma. It is a form of hyperdynamic shock that presents with increased cardiac output, tachycardia, hypotension, and a low systemic vascular resistance.
Treatment is with fluid resuscitation, intravenous antibiotics, and surgical drainage of infection.
Vasopressor agents will exacerbate the systemic shunting that occurs with sepsis and worsen the shock state. Inotropic agents, however, may be required if the patient has insufficient cardiac reserve to maintain the appropriate cardiac output. Swan-Ganz catheterization may be appropriate with assessment of the mixed venous oxygen saturation. Management of Specific Injuries A. Thorax. Penetrating injuries must be evaluated for hemothorax and pneumothorax, and cardiac, great vessel and esophageal injuries.