How to determine whether a trauma patient has traumatic hemorrhagic shock
Nov 05, 2025
Source: Cainiu Health
Dr. Wang Lei
Introduction
In general, to determine whether a trauma patient has traumatic hemorrhagic shock, a comprehensive assessment can be made based on decreased blood pressure, increased heart rate, altered mental status, abnormal skin condition, and reduced urine output. If such signs are observed, immediate first-aid measures should be taken and the patient should be transported to a medical facility as soon as possible. During care, the patient should be kept in a supine position with the lower limbs appropriately elevated to increase venous return.
In general, to determine whether a trauma patient has traumatic hemorrhagic shock, a comprehensive assessment can be made based on decreased blood pressure, increased heart rate, altered mental status, abnormal skin signs, and reduced urine output. If any of these symptoms are observed, immediate first-aid measures should be taken and the patient should be transported to a medical facility as soon as possible. The detailed analysis is as follows:
1. Decreased Blood Pressure
When significant blood loss occurs due to trauma, circulating blood volume decreases and the heart's pumping pressure becomes insufficient, leading to low blood pressure. Typically, systolic blood pressure below 90 mmHg, or a drop exceeding 30% from baseline, may indicate traumatic hemorrhagic shock.
2. Increased Heart Rate
After blood loss, the body compensates for reduced circulating volume by increasing heart rate to maintain blood supply to vital organs. A heart rate exceeding 100 beats per minute—sometimes even higher in severe cases—is one of the key indicators for diagnosing this condition.
3. Altered Mental Status
Inadequate cerebral perfusion affects neurological function, resulting in changes in consciousness. The patient may initially appear restless or anxious; as the condition progresses, they may become apathetic or drowsy, and in severe cases, even lapse into coma. These changes provide a direct reflection of disease severity.
4. Abnormal Skin Signs
Poor circulation reduces skin perfusion, causing the skin to appear pale and feel cold and clammy. Capillary refill time (e.g., after pressing the nail bed) is prolonged, and some patients may develop cyanosis (bluish discoloration). These signs can assist in clinical assessment.
5. Reduced Urine Output
Insufficient renal perfusion leads to decreased glomerular filtration, resulting in oliguria. Normal adult urine output is approximately 30 ml per hour. An hourly urine output below 20 ml, or even anuria (no urine), may indicate traumatic hemorrhagic shock.
During care, the patient should be kept in a supine position with the lower limbs slightly elevated to increase venous return. Keep the patient warm, but avoid excessive bundling that could impair heat dissipation. Closely monitor changes in consciousness, blood pressure, heart rate, and urine output. If symptoms continue to worsen, sustain emergency interventions and transport the patient to hospital promptly. Avoid moving the injured areas unnecessarily during transport to prevent further injury.
