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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?

A. 500-mL blood loss

B. 1000-mL blood loss

C. 1250-mL blood loss

D. 2000-mL blood loss

E. 2500-mL 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.

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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

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?

A. Blood and crystalloid

B. Crystalloid

C. Blood

D. Crystalloid and albumin

E. 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.

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