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Table 2 American College of Surgeons Advanced Trauma Life Support (ATLS) classification of blood loss based on initial patient presentation. Signs and symptoms of haemorrhage by class

From: The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

Parameter

Class I

Class II (mild)

Class III (moderate)

Class IV (severe)

Approximate blood loss

< 15%

15–30%

31–40%

> 40%

Heart rate

↔/↑

↑/↑↑

Blood pressure

↔/↓

Pulse pressure

Respiratory rate

↔/↑

Urine output

↓↓

Glasgow coma scale score

Base deficit*

0 to − 2 mEq/L

− 2 to − 6 mEq/L

− 6 to − 10 mEq/L

− 10 mEq/L or less

Need for blood products

Monitor

Possible

Yes

Massive transfusion protocol

  1. Table reprinted with permission from the American College of Surgeons [53]
  2. Original data from Mutschler et al. [54]
  3. *Base excess is the quantity of base (HCO3, in mEq/L) that is above or below the normal range in the body. A negative number is called a base deficit and indicates metabolic acidosis