Thu18November0317AM 1

A 23-year-old female is admitted to the Emergency department with a ruptured ectopic pregnancy.

Clinical examination is as follows:

Anxious

Capillary refill time of three seconds

Cool peripheries

Pulse 120 beats per minute

Blood pressure 120/95 mmHg

Respiratory rate 22 breaths per minute.

Which one of the following options is most likely to have resulted in these clinical findings?

(Please select 1 option)

Reduction in blood volume of 30-40%

Reduction in blood volume of 0-15%

Reduction in blood volume of 40-50%

Reduction in blood volume of 15-30% Correct

Reduction in blood volume of more than 50%

Explanation

The Advanced Trauma Life Support (ATLS) classification of haemorrhagic shock is as follows:

Class I haemorrhage (blood loss up to 15%):

Minimal tachycardia

No changes in blood pressure, RR or pulse pressure

Normally not require fluid replacement as will be restored in 24 hours, but in trauma correct.

Class II haemorrhage (15-30% blood volume loss):

Uncomplicated haemorrhage requiring crystalloid resuscitation

Represents about 750 - 1500 ml of loss

Tachycardia, tachypnoea and a decrease in pulse pressure (due to a rise in diastolic component due action of catecholamines)

Minimal systolic pressure changes

Anxiety, fright or hostility

Can usually be stabilised by crystalloid, but may later require a blood transfusion.

Class III haemorrhage (30-40% blood volume loss):

Complicated haemorrhagic state in which at least crystalloid and probably blood replacement are required

Classical signs of inadequate perfusion, marked tachycardia, tachypnoea, significant changes in mental state and measurable fall in systolic pressure

Almost always require blood transfusion, but decision based on patient initial response to fluid resuscitation.

Class IV haemorrhage (> 40% blood volume loss):

Preterminal event patient will die in minutes

Marked tachycardia, significant depression in systolic pressure and very narrow pulse pressure (or unobtainable diastolic pressure)

Mental state is markedly depressed

Skin cold and pale

Need rapid transfusion and immediate surgical intervention.

Loss of >50% results in loss of consciousness, pulse and blood pressure.

Answer Statistics

1

22%

2

5%

3

1%

4

74%

Times answered: 240