Flank ecchymosis may indicate retroperitoneal hemorrhage. Extremities Hemorrhage from extremity injuries may be apparent, or tissues may obscure significant bleeding. Femoral fractures may produce significant blood loss. Nervous system Agitation and combativeness may be seen in the initial stages of hemorrhagic shock. These signs are followed by a progressive decline in level of consciousness due to cerebral hypoperfusion or concomitant head injury.
Laboratory studies are essential in management of many forms of hemorrhagic shock.
Baseline levels are determined frequently, but these infrequently change the initial management after trauma. Serial evaluations of the following can help guide ongoing therapy. Lactate and base deficit are used in some centers. Typed and cross-match packed red blood cells should be obtained immediately. Fresh frozen plasma and platelets also may be required to correct coagulopathies that develop in severe hemorrhagic shock.