Ancillary studies often are required for confirmation. Pericardial tamponade - The classic triad of muffled heart sounds, JVD, and hypotension often is present but is difficult to appreciate in the setting of an acute resuscitation. Abdomen Injuries to the liver or spleen are common causes of hemorrhagic shock. However, the patient with altered mental status or multiple concomitant injuries may not manifest the classic signs and symptoms on physical examination. Progressive abdominal distention in hemorrhagic shock is highly suggestive of intraabdominal hemorrhage.
Pelvic fractures can produce massive bleeding.
Retroperitoneal bleeding must be suspected. 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. Neurologic Agitation and combativeness may be seen in the initial stages of hemorrhagic shock.