Hemorrhage Classification

Hemorrhage Classification

• Class I Hemorrhage - Minimal Blood Loss
• Class II Hemorrhage - Mild Blood Loss
• Class III Hemorrhage - Moderate Blood Loss
• Class IV Hemorrhage - Severe Blood Loss

Normal Blood Volume

• Adult: 7% (5 Liter Blood Volume for a 70 kg man)
• Child: 8-9% (80-90 ml/kg for a child)

Class I Hemorrhage - Minimal Blood Loss

1. Characteristics
   1. Blood Volume Loss <15%
   2. Adult blood loss <750 ml
2. Cardiovascular
   1. Heart Rate normal or mild increase
   2. Pulses normal
   3. Blood Pressure normal
   4. pH normal
3. Respiratory: Rate normal
4. Neurologic: Slightly anxious
5. Skin
   1. Warm and pink
   2. Capillary Refill brisk (<2 seconds)
6. Renal: Normal urine output
1. Adults: >0.5 ml/kg/hour (>30 cc/hour)
2. Children: >1 ml/kg/hour
3. Infants <1yo: >2 ml/kg/hour

Class II Hemorrhage - Mild Blood Loss

1. Characteristics
   1. Blood Volume Loss: 15-30%
   2. Adult: 750-1500 ml of blood loss
2. Cardiovascular
   1. Tachycardia
   2. Diminished peripheral pulses
   3. Blood Pressure normal
   4. Normal pH
3. Respiratory
   1. Mild Tachypnea
4. Neurologic
   1. Irritable
   2. Confused
   3. Combative
5. Skin
   1. Cool extremities
   2. Mottling
   3. Delayed Capillary Refill
6. Renal
1. Oliguria
2. Increased specific gravity

Class III Hemorrhage - Moderate Blood Loss

1. Characteristics
   1. Blood Volume Loss: 30-40%
   2. Adults: 2000 ml blood loss
2. Cardiovascular
   1. Significant Tachycardia
   2. Thready peripheral pulses
   3. Hypotension
   4. Metabolic Acidosis
3. Respiratory: Moderate Tachypnea
4. Neurologic
   1. Irritable
   2. Lethargic
   3. Diminished pain response
5. Skin
   1. Cool extremities, mottling or pallor
   2. Prolonged Capillary Refills
6. Renal
1. Oliguria
2. Blood Urea Nitrogen (BUN) increased

Class IV Hemorrhage - Severe Blood Loss

1. Characteristics
   1. Blood Volume Loss: >40%
2. Cardiovascular
   1. Severe Tachycardia
   2. Thready central pulses
   3. Significant Hypotension
   4. Significant acidosis
3. Respiratory: Severe Tachypnea
4. Neurologic
   1. Lethargic
   2. Coma
5. Skin
   1. Cold extremities
   2. Pallor
   3. Cyanosis
6. Renal
   1. Anuria