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Table 3 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. Table reprinted with permission from the American College of Surgeons [111]

From: The European guideline on management of major bleeding and coagulopathy following trauma: fifth 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. *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
  2. Original data from Mutschler et al. [117]
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Critical Care

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