Understanding "+HS" in Motor Vehicle Accident Reports
"+HS" in a motor vehicle accident report indicates the presence of hemorrhagic shock, a life-threatening condition requiring immediate recognition and intervention.
Clinical Significance in MVA Context
Motor vehicle crashes are the leading cause of pelvic fractures (approximately 60%) and are strongly associated with massive hemorrhage and hemorrhagic shock. 1
Key Associations with MVAs:
- High-energy mechanisms from motor vehicle crashes produce severe damage to both skeletal structures and internal organs, with more than 75% of patients having associated head, thorax, abdominal, or genitourinary injuries. 1
- Unstable pelvic fractures from MVAs are strongly correlated with massive hemorrhage, and hemorrhage remains the leading cause of death in patients with major pelvic fractures. 1
- Patients with high-energy injuries from MVAs require significantly more transfusion units compared to lower-energy mechanisms. 1
Recognizing Hemorrhagic Shock Severity
The ATLS classification system categorizes hemorrhagic shock into four classes based on blood loss and physiological parameters: 1
Class III-IV Hemorrhagic Shock (Most Critical):
- Blood loss: 1,500-2,000+ ml (30-40%+ of blood volume) 1
- Heart rate: >120-140 bpm 1
- Systolic blood pressure: Decreased 1
- Mental status: Anxious, confused, or lethargic 1
- Urine output: <15 ml/h or negligible 1
Immediate Management Implications
Patients presenting with hemorrhagic shock and an identified source of bleeding must undergo immediate bleeding control procedures unless initial resuscitation measures are successful. 1
Critical Action Steps:
- For hemodynamically unstable patients with significant free intra-abdominal fluid, urgent surgical intervention is required rather than additional imaging. 2, 3
- Blood transfusion without hemorrhage source control does not prevent death in exsanguinating trauma patients—mechanical stabilization and/or surgical control is paramount. 2
- Mortality increases approximately 1% every 3 minutes of delay in controlling significant internal hemorrhage. 2
Common Pitfalls to Avoid
The most critical error is delaying definitive bleeding control in favor of continued resuscitation and transfusion without addressing the hemorrhage source. 2 This approach fails because:
- Trauma-induced coagulopathy worsens with ongoing bleeding, creating a vicious cycle where transfused blood products cannot compensate for continued blood loss. 2
- Transfusion alone is an adjunct, not primary treatment—immediate bleeding control procedures are required for patients in hemorrhagic shock. 2, 4
A negative FAST examination does not exclude retroperitoneal bleeding or specific organ injuries, so clinical suspicion must remain high in MVA patients with shock. 2