The correct answer is B. Hypovolemic shock.

Key findings in this scenario:

Sudden “tearing” chest pain → classic sign of aortic dissection or rupture

Hypotension (BP 88/52)

Tachycardia (P 128)

Pale, cool, clammy skin

Clear lung sounds

Why this indicates hypovolemic shock:

A tearing chest pain strongly suggests a vascular catastrophe (e.g., aortic dissection/rupture), which can lead to internal bleeding. This results in:

Loss of circulating blood volume

Decreased perfusion

Signs of hypovolemic shock

NREMT-aligned guidance states:

“Hypovolemic shock results from significant fluid or blood loss.”

“Patients present with hypotension, tachycardia, and cool, pale skin.”

Why NOT cardiogenic shock (C):

Although the patient has a cardiac history:

Cardiogenic shock typically presents with:

Pulmonary edema (crackles)

Signs of heart pump failure

This patient has clear lung sounds, which argues against cardiogenic shock

Why the other options are incorrect:

A. PsychogenicCauses temporary fainting, not sustained hypotension with shock signs

D. SepticUsually presents with warm skin (early) and signs of infection, not tearing chest pain

Exact Extracts (NREMT-aligned EMT educational references):

“Hypovolemic shock is caused by blood or fluid loss.”

“Signs include hypotension, tachycardia, and cool, pale skin.”

“Internal bleeding can result in hypovolemic shock.”

Clinical Priority Summary:

The tearing chest pain with hypotension and signs of poor perfusion strongly suggests internal hemorrhage, leading to hypovolemic shock, making B the correct answer.