CLASSIFICATION OF ACUTE HEMORRHAGE

Causes of Intravascular Volume Loss

Hemorrhagic hypovolemia    Thorax     Pulmonary parenchymal trauma     Pulmonary vascular injury     Intercostal vascular injury     Aortic disruption     Massive hemoptysis   Abdomen/pelvis/retroperitoneum     Solid organ injuries (liver, spleen, kidney)     Vascular (trauma, aneurysmal rupture)     Gastrointestinal hemorrhage (esophageal varices, ulcers, vascular anomalies, etc.)     Gynecologic disorders (ruptured ectopic pregnancy, peripartum hemorrhage, abnormal uterine bleeding, ovarian cyst rupture, etc.)   Orthopedic     Pelvic fracture     Large bone fractures     Multiple fractures   Extremity and skin surface     Major vascular injuries     Large soft tissue injuries Nonhemorrhagic hypovolemia    Gastrointestinal disorders: vomiting, diarrhea, ascites   Burns   Environmental exposure or neglect   Renal salt wasting

(Tintinali, 2006)

Diagnostic Evaluation in Acute Hemorrhage

Laboratory studies    Hemoglobin/hematocrit   Arterial blood gases   Lactate   Electrolytes, blood urea nitrogen, creatinine, glucose, calcium   Coagulation studies   Platelet count   Type and cross-match Studies to evaluate sources of blood loss (as indicated)    Chest radiograph   Pelvic radiograph   Abdominal/pelvic CT   Abdominal ultrasonography   Chest CT   GI endoscopy   Bronchoscopy   Vascular radiology

(Tintinali, 2006)

In emergency case, all have the same way of management as systematically :
Air way 
Breathing 
Circulation : in this acute blood loss case, look at the table classification of acute hemorrhage, and 
                     make sure that stop the bleeding while improving circulation
Dissability
Exposure

American College of Surgeon Classification of Acute Hemorrhage

	Class I	Class II	Class III	Class IV
Blood loss (mL)	<750	750 - 1,500	1,500 - 2000	≥2000
% Blood Volume lost	<15	15-30	30-40	≥40
Pulse Rate	<100	>100	>120	≥140
Blood Pressure	Normal	Normal	Decreased	Decreased
Pulse Pressure (mmHg)	Normal or Increased	Decerased	Decreased	Decreased
Capillary Refill	Normal	Delayed	Delayed	Delayed
Respiratory Rate	14-20	20-30	30-40	>35
Urine Output	>30	20-30	15-15	Negligible
Mental Status	slightly anxious	Mildly anxious	anxious, confused	Confused, Lethargic
Recommended Fluid Replacement	0.9% Saline, 3:1	0.9% Saline, 3:1	0.9% Saline + redcells	0.9% Saline + redcells

Acute blood loss is a very common problem following injury.


Sumber :
- www.itaccs.com (Trauma Care The Journal of International Trauma Care, vol.18-2008 Number 1)
- Tintinali, 2006, Fluid and Blood Resuscitation Introduction: Tintinali's Emergency Medicine, The McGraw-Hill, American College of Emergency Physicians