Chapter 31. General Trauma, Hemorrhage, and Burn
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?
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.
Table 31-1. Classes of Hemorrhagic Shock
|Class of Shock ||Blood Volume Lost ||Findings |
|I || |
<15% of blood volume
Normal heart rate, blood pressure, capillary refill, pulse pressure
Slightly anxious affect
|II || |
15%-30% of blood volume
Normal mean arterial pressure (MAP), increased diastolic blood pressure (DBP), mild tachycardia
|III || |
30%-40% of blood volume
Reduced MAP, systolic blood pressure (SBP), DBP, tachycardia >120 bpm
Anxious and confused
|IV || |
>40% of blood volume
Severely reduced MAP, SBP, DBP, tachycardia >140 bpm
Confused to lethargic
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?
D. Crystalloid and albumin
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.