Abstract Background: Non-traumatic shock is a major cause of morbidity and mortality in emergency departments worldwide. In resource-limited countries like Ethiopia, where emergency care systems experience significant constraints, early identification and management of shock are critical yet often challenging. However, evidence on its patterns, outcome, and predictors of mortality remains limited in Ethiopia and the study area as well. Objective: This study aimed to assess the pattern, treatment outcome, and associated factors of non-traumatic shock among adult patients presenting to the emergency department of Tibebe Ghion Specialized Hospital, Ethiopia, between January 1,2022, and December 31, 2025. Methods: A hospital-based retrospective cross-sectional study was conducted among adult patients admitted with non-traumatic shock between January 1, 2022, and December 31, 2025. Medical records were reviewed to extract socio-demographic, clinical, laboratory, and treatment-related data. Data quality was ensured through pretested tools and regular supervision. Descriptive statistics were used to summarize patient characteristics. Multivariable binary logistic regression analysis was performed to identify independent predictors of mortality, with adjusted odds ratios (AOR) and 95% confidence intervals (CI). Results:A total of 422 patient cards were identified for assessment, of which 32 incomplete recordswere excluded, resulting in 390 eligible cards and a response rate of 92.4%. Septic shock was the most common type of non-traumatic shock (43.1%),followed by hypovolemic shock (33.1%) and cardiogenic shock (14.9%). The overall mortalitywas 17.7%. Night-time presentation to the emergency department (AOR = 2.0, 95% CI: 1.10–3.64), use of vasopressors (AOR = 2.28, 95% CI: 1.04–5.01), elevated creatinine levels >1.2 mg/dl (AOR = 4.34, 95% CI: 1.72–10.9), and presence of chronic liver disease(AOR = 3.81, 95% CI: 1.40–10.4) were significantly associated with mortality. Conclusion and Recommendation: Non-traumatic shock remains a significant contributor to mortality in the emergency department, with septic shock being the most common type. Mortality is strongly influenced by both patient and system-related factors. Therefore, strengthening night-shift staffing, improving renal monitoring capacity, ensuring wise use of vasopressors, and prioritizing care for patients with chronic liver disease are essential strategies for reducing mortality.