Class 4 hemorrhage

Q: In severe hemorrhage due to trauma, aggressive intravenous (IV) resuscitation should be initiated as soon as possible? (select one)

A) True
B) False 


Answer: B

Hemorrhage in trauma has been divided into 4 classes.

• Up to 15 percent of blood loss is called Class I hemorrhage. It constitutes minor hemodynamic changes
• 15 to 30 percent of blood loss is designated as Class II hemorrhage. With moderate hemodynamic changes, it makes skin cool and clammy, and delayed capillary refill
•  30 to 40 percent blood loss is under Class III hemorrhage. At this point changes in mental status is usually visible with paradox decrease in anxiety or pain
• More than 40 percent of blood loss constitutes Class 4 hemorrhage with a significant change in hemodynamics and mental status.

Treatment of hemorrhage with trauma is with blood products. Aggressive IV resuscitation beyond need increases the risk of coagulopathy from dilution of clotting factors and platelets. It may also aggravate hypothermia.

#trauma


References:

1. Brown JB, Cohen MJ, Minei JP, et al. Goal-directed resuscitation in the prehospital setting: a propensity-adjusted analysis. J Trauma Acute Care Surg 2013; 74:1207. 

2. Neal MD, Hoffman MK, Cuschieri J, et al. Crystalloid to packed red blood cell transfusion ratio in the massively transfused patient: when a little goes a long way. J Trauma Acute Care Surg 2012; 72:892. 

3. Duchesne JC, Heaney J, Guidry C, et al. Diluting the benefits of hemostatic resuscitation: a multi-institutional analysis. J Trauma Acute Care Surg 2013; 75:76.