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Chapter 31. General Trauma, Hemorrhage, and Burn

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A 70-kg man sustains a gunshot wound to the left groin. Paramedics report a large-volume blood loss at the scene but are unable to quantify the amount. On arrival, he is anxious and combative, his blood pressure is 100/76 mm Hg, and his pulse rate is 130 bpm. Which of the following is the best estimate of his blood loss?

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A. 500-mL blood loss

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B. 1000-mL blood loss

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C. 1250-mL blood loss

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D. 2000-mL blood loss

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E. 2500-mL blood loss

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D. This patient is in class 3 hemorrhage shock, as evidenced by his tachycardia and hypotension. He is anxious and combative, but not yet lethargic, as is seen in class 4 hemorrhagic shock. Estimated blood loss in class 3 hemorrhagic shock is 1500 to 2000 mL, or 30% to 40% of the blood volume. This question focuses on the classification of hemorrhagic shock. Hemorrhagic shock can be divided into 4 classes as shown in Table 31-1.

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Table 31-1. Classes of Hemorrhagic Shock
Class of Shock Blood Volume Lost Findings
I

<15% of blood volume

<750 mL

Normal heart rate, blood pressure, capillary refill, pulse pressure

Slightly anxious affect

II

15%-30% of blood volume

750–1500 mL

Normal mean arterial pressure (MAP), increased diastolic blood pressure (DBP), mild tachycardia

Mildly anxious

III

30%-40% of blood volume

1500–2000 mL

Reduced MAP, systolic blood pressure (SBP), DBP, tachycardia >120 bpm

Anxious and confused

IV

>40% of blood volume

>2000 mL

Severely reduced MAP, SBP, DBP, tachycardia >140 bpm

Confused to lethargic

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A 34-year-old man is involved in a motor vehicle collision and sustains a large laceration to his forehead and an open femur fracture. Per report, the paramedics noted a large amount of blood at the scene. On arrival, he is anxious and combative, his blood pressure is 90/50 mm Hg, and his pulse rate is 130 bpm. Which of the following is the most appropriate initial resuscitation fluid?

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A. Blood and crystalloid

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B. Crystalloid

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C. Blood

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D. Crystalloid and albumin

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E. Albumin

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A. This patient is in class 3 hemorrhage, as evidenced by his tachycardia and hypotension. He is anxious and combative, but not yet lethargic, as is seen in class 4 hemorrhagic shock. The appropriate resuscitation fluid in class 3 hemorrhagic shock is a combination of crystalloid and blood.

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