According to ATLS classification of haemorrhagic shock, a patient with estimated blood loss of 1,500 mL (class III shock) would be expected to show which combination of clinical signs?

• A HR 80, BP normal, RR 12–20, normal mental status
• B HR 120–140, BP decreased (pulse pressure narrowed), RR 30–40, confused/anxious mental status ✓
• C HR >140, BP very low, RR >35, lethargic/confused
• D HR 100–120, BP normal (compensated), RR 20–30, mildly anxious

Explanation

ATLS haemorrhagic shock classification: Class I (<15% BV, <750 mL) — normal HR, BP, RR; Class II (15–30%, 750–1500 mL) — HR 100–120, BP normal/pulse pressure narrowed, RR 20–30, anxious; Class III (30–40%, 1500–2000 mL) — HR 120–140, decreased BP, RR 30–40, confused; Class IV (>40%, >2000 mL) — HR >140, severely decreased BP, RR >35, lethargic/obtunded. 1,500 mL sits at the upper end of Class II/lower Class III boundary but with BP now decreased and the classic Class III features.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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