Vital signs Blood loss can be estimated based on heart rate, blood pressure, respiratory rate, and mental status. Advanced trauma life support (ATLS) by the American College of Surgeons separates hemorrhagic shock into four categories. +Classification of Hemorrhagic Shock Estimated blood loss Heart rate (per minute) Blood pressure Pulse pressure (mmHg) Respiratory rate (per minute) Other Class I hemorrhage 15% Normal or minimally elevated Normal Normal Normal * Slightly anxious Class II hemorrhage 15 - 30% 100 - 120 Normal or minimally decreased systolic blood pressure Narrowed 20 - 30 * Mildly anxious *Cool, clammy skin with delayed capillary refill Class III hemorrhage 30 - 40% 120 - 140 Systolic blood pressure 20-30% from presentation Narrowed 30 - 40 * Altered mental status (anxious, confused) * Decreased urine output Class IV hemorrhage > 40% > 140 Systolic blood pressure 25 mmHg) >35 * Significantly altered mental status (confused, lethargic) * Cool, clammy skin with delayed capillary refill * Significantly decreased or absent urine output Assessing circulation occurs after assessing the patient's airway and breathing (ABC (medicine)). If<unk>  is suspected, a patient's circulatory system is assessed through palpation of pulses and doppler ultrasonography. Physical examination It is important to examine the person for visible signs that may suggest<unk> : * a wound *ecchymosis * blood collection hematoma * abnormal skin sensation paresthesia * signs of compartment syndrome It is also important to look for the source of the<unk> . If<unk>  is suspected after trauma, a FAST exam may be performed to look for bleeding in the abdomen. Imaging If the patient has stable vital signs, they may undergo diagnostic imaging such as a CT scan. If the patient has unstable vital signs, they may not undergo diagnostic imaging and instead may receive immediate medical or surgical treatment. By location<unk>  can occur anywhere in the body. Some symptoms of<unk>  depend on the location of the bleed. Some examples of types of<unk>  include: *Head: Intracranial hemorrhage, cerebral hemorrhage, subarachnoid hemorrhage, subdural hematoma, epidural hematoma *Torso: cardiac tamponade, pulmonary hemorrhage, hemothorax, aortic aneurysm, gastrointestinal bleeding (upper gastrointestinal bleeding, lower gastrointestinal bleeding), blunt kidney trauma, splenic injury retroperitoneal bleeding, postpartum bleeding, ectopic pregnancy *Extremities: bone fracture, hemarthrosis
Internal bleeding
Gastrointestinal bleeding
Implantation bleeding
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Cancer signs and symptoms