EMT Chapter 25-MCIT-F3-2211 | Bridging the Gap:  This course on Hemorrhagic shock deals knowledge that will help you save lives when seconds count. This chapter prepares EMTs to function confidently within modern prehospital blood transfusion programs by strengthening recognition, decision-making, and team based based execution. 

The lessons covered are

• Lesson 1: Hemorrhagic Shock – Advanced Recognition and Modern Management
• Lesson 2: Blood Products in the Field – What, Why, and How
• Lesson 3: The EMT’s Expanded Role in Blood Transfusion
• Lesson 4: Patient Monitoring During Blood Transfusion
• Lesson 5: Transfusion Safety and Adverse Reactions

Excerpt from EMT Chapter 25-MCIT-F3-2211 | Bridging the Gap

Now let’s talk about what you’re actually looking for when you assess a patient for hemorrhagic shock. These clinical signs are gold – they often show up before the vital signs crash, giving you that critical early warning.  First, watch the mental status. The brain is exquisitely sensitive to drops in perfusion. Early shock often presents as anxiety or restlessness – the patient seems ‘off’ or agitated for no clear reason. As shock progresses, you’ll see confusion, then decreased responsiveness. If your trauma patient is altered and you can’t explain it with a head injury, think shock.  Next, assess the skin. This is one of the most reliable indicators we have. When the body starts shunting blood away from the skin to preserve core organs, you’ll see it become pale, cool, and often clammy or diaphoretic.

Some folks call this ‘shocky skin’. You know it when you feel it. Check peripheral pulses – are they strong and bounding, or weak and thready? In significant shock, you might not even be able to feel pedal pulses.  Capillary refill is controversial in adults, but it’s still worth checking. Anything over 2 seconds is concerning in a warm environment. Also look at pulse pressure – that’s the difference between systolic and diastolic BP. Normal is around 40 mmHg. If you see a narrow pulse pressure, say 110 over 95, that’s only 15 mmHg and it suggests the heart is working hard to maintain pressure while blood volume is dropping. These are the clinical pearls that separate good EMTs from great ones. Don’t just look at the monitor – look at your patient.