Resuscitation of major trauma victims suffering from shock remains a challenge for trauma systems and trauma centers. Rapid identification, and ensuring correct, aggressive treatment, are necessary for patient survival. This article discusses shock encountered in trauma victims: hypovolemic, cardiogenic, obstructive, and distributive shock. Emphasis is placed on hypovolemic shock and its sequelae. The critical care nurse plays an important role as part of the team involved in the resuscitation and ongoing care of these patients. Understanding the underlying pathophysiology, recognizing signs and symptoms, and being prepared to effectively respond will further enable the nurse to contribute to positive patient outcomes.