Emergency Medicine Book

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Hemorrhage Classification

Aka: Hemorrhage Classification, Classes of Hemorrhagic Shock, Class I Hemorrhage, Class II Hemorrhage, Class III Hemorrhage, Class IV Hemorrhage
  1. General: Blood Volume
    1. Adult: 7% (5 Liter Blood Volume for a 70 kg man)
    2. Child: 8-9% (80-90 ml/kg for a child)
  2. Findings: Class I Hemorrhage - Minimal Blood Loss
    1. Characteristics
      1. Blood Volume Loss <15%
      2. Adult blood loss <750 ml
    2. Cardiovascular
      1. Heart Rate normal or mild increase
      2. Pulses normal
      3. Blood Pressure normal
      4. pH normal
    3. Respiratory: Rate normal
    4. Neurologic: Slightly anxious
    5. Skin
      1. Warm and pink
      2. Capillary Refill brisk (<2 seconds)
    6. Renal: Normal urine output
      1. Adults: >0.5 ml/kg/hour (>30 cc/hour)
      2. Children: >1 ml/kg/hour
      3. Infants <1yo: >2 ml/kg/hour
  3. Findings: Class II Hemorrhage - Mild Blood Loss
    1. Characteristics
      1. Blood Volume Loss: 15-30%
      2. Adult: 750-1500 ml of blood loss
    2. Cardiovascular
      1. Tachycardia
      2. Diminished peripheral pulses
      3. Blood Pressure normal
      4. Normal pH
    3. Respiratory
      1. Mild Tachypnea
    4. Neurologic
      1. Irritable
      2. Confused
      3. Combative
    5. Skin
      1. Cool extremities
      2. Mottling
      3. Delayed Capillary Refill
    6. Renal
      1. Oliguria
      2. Increased specific gravity
  4. Findings: Class III Hemorrhage - Moderate Blood Loss
    1. Characteristics
      1. Blood Volume Loss: 30-40%
      2. Adults: 2000 ml blood loss
    2. Cardiovascular
      1. Significant Tachycardia
      2. Thready peripheral pulses
      3. Hypotension
      4. Metabolic Acidosis
    3. Respiratory: Moderate Tachypnea
    4. Neurologic
      1. Irritable
      2. Lethargic
      3. Diminished pain response
    5. Skin
      1. Cool extremities, mottling or pallor
      2. Prolonged Capillary Refills
    6. Renal
      1. Oliguria
      2. Blood Urea Nitrogen (BUN) increased
  5. Findings: Class IV Hemorrhage - Severe Blood Loss
    1. Characteristics
      1. Blood Volume Loss: >40%
    2. Cardiovascular
      1. Severe Tachycardia
      2. Thready central pulses
      3. Significant Hypotension
      4. Significant acidosis
    3. Respiratory: Severe Tachypnea
    4. Neurologic
      1. Lethargic
      2. Coma
    5. Skin
      1. Cold extremities
      2. Pallor
      3. Cyanosis
    6. Renal
      1. Anuria

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