A 25-year-old motorcycle rider is brought to the emergency with history of motor vehicle accident. On examination, the patient is tachycardic (pulse 110/min) with a BP of 90 systolic. He has an open wound in the thigh with an estimated blood loss of 1000 mL. What is the severity of haemorrhagic shock this patient is suffering from?
Class 2
The correct answer is Class 2. The ATLS classification uses percentage blood volume lost, adult blood volume being about 70 mL/kg (5 litres in a 70 kg adult). Class II is a loss of 15-30% (750-1500 mL), with heart rate 100-120/min, narrowed pulse pressure from catecholamine-driven vasoconstriction, respiratory rate 20-30/min, urine output 20-30 mL/hour and mild anxiety. A 1000 mL loss (about 20%) with a pulse of 110/min fits precisely. Manage with direct pressure, warmed crystalloid and reassessment for ongoing bleeding.
Class 1 is up to 15% (750 mL) with heart rate below 100/min and normal vitals. Class 3 is 30-40% (1500-2000 mL) with heart rate 120-140/min, frank hypotension, urine output 5-15 mL/hour and confusion, requiring blood. Class 4 is over 40% with heart rate above 140/min, negligible urine output and collapse needing massive transfusion.
Key point: Class boundaries are 750, 1500 and 2000 mL. Systolic pressure falls only from Class III, so tachycardia and narrowed pulse pressure are the earliest reliable signs.
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