Patients with abdominal trauma may require significant resuscitation and analgesia prior to formal abdominal assessment (Fig 1). In all cases where there is suspicion of abdominal trauma and blood loss, an urgent cross-match sample must be sent.

In haemorrhagic shock, the priority is resuscitation to restore adequate tissue perfusion and oxygen delivery. Adequate intravenous analgesia should be administered promptly and not delayed whilst investigations are obtained.

Learning bite

A patient should always receive adequate intravenous opioid analgesia titrated to clinical response.

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Fig 1 Fluid replacement therapy and analgesia for the patient in hypovolaemic shock


Management of Haemorrhagic Shock

Normal saline is the recommended initial intravenous resuscitation fluid. High flow oxygen and blood products, if appropriate, will maximise the oxygen-carrying potential of the intravascular fluid.

Management of haemorrhagic shock involves restoration and maintenance of circulating volume and tissue perfusion until bleeding is controlled. A patient who is GCS 15 and physiologically normal can be viewed as being adequately resuscitated, although frequent reassessment of this state is required. A patient who is initially haemodynamically normal and has no sign of significant abdominal injury can be treated in an observant fashion.

Table 1 The grades of hypovolaemic shock

  Grade I Grade II Grade III Grade IV
Blood loss <750ml 750-1500ml 1500-2000ml >2000ml
Pulse normal tachy tachy weak
Blood pressure normal raised diastolic lowered systolic very low
Mental state normal agitated confused obtunded
Urine output 30ml/h 20-30ml/h 5-15ml/h <5 ml/h
Respiratory rate normal normal tachypnoeic tachypnoeic