From the Guidelines
The patient is in third stage shock, also known as class III hemorrhagic shock, based on the provided vital signs. The patient's systolic blood pressure of 80 mmHg, diastolic pressure of 60 mmHg, heart rate of 110 beats per minute, and respiratory rate of 20 breaths per minute indicate significant blood volume loss and failing compensatory mechanisms 1. According to the European guideline on management of major bleeding and coagulopathy following trauma, a systolic blood pressure of 80-90 mmHg is considered a target for permissive hypotension in patients without TBI and/or spinal injury 1. However, the patient's vital signs suggest that they are at risk for progression to irreversible shock if not treated promptly. The Advanced Trauma Life Support (ATLS) definition considers a patient with a blood pressure < 90 mmHg and heart rate > 120 bpm as "unstable" 1. Although the patient's heart rate is 110 beats per minute, which is slightly below the threshold, their blood pressure is significantly low, indicating third stage shock. Immediate fluid resuscitation, possibly with blood products, and close monitoring are necessary to prevent further deterioration. It is essential to note that the concept of permissive hypotension and restrictive volume resuscitation should be carefully considered in elderly patients and may be contraindicated if the patient suffers from chronic arterial hypertension 1. In this case, the patient's age and medical history are not provided, but the focus should be on achieving a balance between volume resuscitation and vasopressor administration to ensure adequate perfusion pressure. The patient's treatment should be guided by the most recent and highest quality evidence, which prioritizes morbidity, mortality, and quality of life as the outcome 1.
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.
- The provided studies do not directly address the classification of shock based on vital signs 2, 3, 4, 5, 6.
- However, it is known that shock can be classified into different stages, including hypovolemic shock, cardiogenic shock, and septic shock.
- The patient's vital signs suggest hypovolemic shock, which can be classified into four stages:
- Stage I: Compensated shock, with minimal symptoms and no significant vital sign abnormalities.
- Stage II: Mild to moderate shock, with mild to moderate vital sign abnormalities, such as tachycardia and decreased blood pressure.
- Stage III: Severe shock, with significant vital sign abnormalities, such as marked tachycardia and hypotension.
- Stage IV: Refractory shock, with severe vital sign abnormalities and organ dysfunction.
Determining the Grade of Shock
Based on the patient's vital signs, we can determine the grade of shock.
- The patient's blood pressure is 80/60, which is significantly decreased.
- The patient's heart rate is 110, which is increased.
- The patient's respiratory rate is 20, which is slightly increased.
- Considering these vital sign abnormalities, the patient's grade of shock is likely Stage II or Stage III.
- However, without more information about the patient's clinical presentation and medical history, it is difficult to determine the exact grade of shock.
Answer
Based on the patient's vital signs, the correct answer is:
- A. Second stage (Stage II) or
- B. Third stage (Stage III) However, the most likely answer based on typical classification is
- A. Second stage.