Soft Signs of Vascular Trauma
The soft signs of vascular trauma include those assessment findings that are highly suspicious for vascular injury that require further investigation and a high index of suspicion for life-threatening hemorrhage.
- History of moderate hemorrhage at the scene, which usually comes in the form of a first responder or bystander reporting a massive amount of blood on the scene.
- Penetrating wound(s) in proximity to vascular structures.
- Fracture or dislocation patterns.
- Diminished pulse distal to the injury.
- Non-expanding hematoma.
- Extremity peripheral nerve deficit.
Assessment of the patient in hemorrhagic shock should focus on finding the source of the hemorrhage and controlling it before the more overt signs of shock are present. The chart below can give an EMS provider a general overview of the physiologic picture of patients as they progress through the various stages/classes of hemorrhagic shock. It is ill-advised to wait until a patient has a noticeable or drastic change in their vital signs. EMS providers should be keenly aware of any changes in mental status and assume that those changes are associated with an occult hemorrhage and begin resuscitating the patient accordingly.
