From the Guidelines
The patient is experiencing Class III (Third stage) shock based on the vital signs provided, with a blood pressure of 80/60 mmHg, heart rate of 110 beats per minute, and respiratory rate of 20 breaths per minute, indicating significant hypotension and compensatory tachycardia. This classification is supported by the most recent and highest quality study, which defines hemodynamic instability in adults as a condition in which the patient has an admission systolic blood pressure < 90 mmHg, or > 90 mmHg but requiring bolus infusions/transfusions and/or vasopressor drugs and/or admission base excess (BE) > −5 mmol/l and/or shock index > 1 1. The patient's vital signs align with the definition of third stage shock, which typically involves blood volume loss of approximately 30-40% and is characterized by marked hypotension, tachycardia, decreased pulse pressure, altered mental status, and reduced urine output.
The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition, published in 2023, supports the concept of restricted volume replacement and permissive hypotension in the early stages of resuscitation, with a target systolic blood pressure of 80–90 mmHg 1. However, in this patient's case, immediate intervention with aggressive fluid resuscitation and possibly blood products is necessary to prevent progression to irreversible (fourth stage) shock.
Key characteristics of third stage shock include:
- Marked hypotension
- Tachycardia
- Decreased pulse pressure
- Altered mental status
- Reduced urine output The patient's presentation is consistent with these characteristics, and therefore, the most appropriate classification is Class III (Third stage) shock.
From the Research
Classification of Shock
The patient's vital signs are: blood pressure 80/60, HR 110, RR 20. To determine the grade of shock, we need to consider the classification of shock. However, the provided studies do not directly address the classification of shock based on vital signs.
Available Information
- The studies provided focus on the treatment of shock, including fluid resuscitation strategies and the use of vasopressors 2, 3, 4, 5.
- One study discusses the understanding of shock, including its types, signs, and symptoms, but does not provide a clear classification based on vital signs 6.
Limitations
- There is no direct information available in the provided studies to determine the grade of shock based on the patient's vital signs.
- The studies focus on the treatment and management of shock, rather than its classification.
Possible Approach
- Consider consulting other resources or studies that specifically address the classification of shock based on vital signs.
- Look for studies that provide a clear definition of the different stages of shock, including the corresponding vital sign parameters.