Hemorrhage
A hemorrhage is defined as a loss of blood over a short period of time. A hemorrhage may be internal (within the body tissues) or external (on the skin's surface).
A hemorrhage can be caused by trauma, creating a rupture in the blood vessels or may be the result of a disease process which affects the vessel walls or even the blood itself. A hemorrhage from traumatic bleeding can be caused by abrasions, lacerations, puncture wounds, gunshot wounds or any other type of injury, although bleeding might not be readily apparent. Medical bleeding is that associated with an underlying medical condition or disease.
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A hemorrhage can be as small as pin-sized dots (petechiae) or a large localized mass of blood in the tissue (hematoma).
There are four classes of hemorrhage:
Class I is indicated by minimal blood loss, a normal or slightly increased heart rate and normal respiration and blood pressure. The patient may be slightly anxious; skin is warm and pink.
Class II hemorrhage demonstrates mild blood loss and tachycardia (rapid heartbeat). Although the patient's blood pressure remains normal, he may become irritable, confused or combative and the extremities will feel cool and may be blotchy or mottled.
In Class III, there is moderate blood loss and significant tachycardia. The patient is also beginning to breathe rapidly, his blood pressure is falling and he is irritable, lethargic and has diminished pain response. At this level of hemorrhage, fluid resuscitation is usually required.
In the most serious category, Class IV hemorrhage, blood volume loss is greater than 40% of the total circulating volume. The patient will exhibit severe tachycardia, a thready pulse, extremely low blood pressure and very rapid breathing. Extremities will be cold and skin will begin to look blue. Aggressive, quick treatment is required to prevent coma and death.