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Hemorrhagic shock is divided into four classes - class I is <15% loss and shows compensation for the blood loss (no tachycardia/hypotension) and is treated with crystalloid replacement as necessary. Class II is a loss of 15-30% and is the target of this question. In this class, vasoconstriction leads to maintenance of perfusion pressure and tachycardia helps maintain cardiac output in the face of a decreased overall volume. The vasoconstriction leads to an elevated diastolic pressure, which is the cause of the narrowed pulse pressure (the difference between systolic and diastolic). Treatment remains control of ongoing bleeding and crystalloid replacement. Class III is a 30-40% loss, and is the first stage where hypotension is present. Signs of end organ hypoperfusion, such as confusion and decreased urine output, is seen. Treatment is crystalloid replacement and blood product replacement. Class IV is a loss of >40% and is often fatal. Hak reviews the ATLS classification of hemorrhage in his review article on pelvic fractures and bleeding. Illustration A shows the hemorrhagic shock class table.
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