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Cerebral injury: Shock from concussion of the brain secondary to cranial contusion or fracture or spontaneous hemorrhage. The shock may be evident immediately or later due to edema or delayed intracranial hemorrhage. Chemical injury: Shock due to physiological response to tissue injury, such as fluid mobilization, toxicity of the agent, and reflexes induced by pain due to the effect of chemicals, esp. corrosives. Crushing injury: Shock caused by disruption of soft tissue with release of myoglobulins, hemorrhage, and so forth, generally proportional to the extent of the injury. Fracture (esp. open fracture): Shock due to blood loss, fat embolism, and the physiological effects of pain. Heart damage: Shock caused by myocardial infarction, myocarditis, pericarditis, pericardial tamponade, or direct trauma with ensuing cardiovascular effects. Inflammation: Shock caused by severe sepsis, for example, peritonitis due to release of toxins affecting cardiovascular function and significant fluid mobilization. Intestinal obstruction: Shock caused by respiratory compromise due to distention, fluid mobilization, release of bacterial toxins, and pain. Nerve injury: Shock caused by injury to the area controlling respirations (e.g., high cervical cord injury) or to highly sensitive parts, such as the testicle, solar plexus, eye, and urethra, or secondary to cardiovascular reflexes stimulated by pain. Operations: Shock that may occur even after minor operations and paracentesis or catheterization due to rapid escape of fluids resulting in abrupt alteration of intra-abdominal pressure dynamics and hemorrhage. Perforation or rupture of viscera: Shock resulting from acute pneumothorax, ruptured aneurysm, perforated peptic ulcer, perforation of appendicial abscess or colonic diverticulum, or ectopic pregnancy. Strangulation: Shock resulting from strangulated hernia, intussusception, or volvulus. Thermal injury: Shock caused by burn, frostbite, or heat exhaustion secondary to fluid mobilization due to the physiological effects of pain. Torsion of viscera: Shock caused by torsion of an ovary or a testicle secondary to the physiological effects of pain.