According to ATLS classification, which of the following represents Class III hemorrhagic shock?

Explanation

## ATLS Classification of Hemorrhagic Shock **Key Point:** The ATLS classification divides hemorrhagic shock into four classes based on blood loss percentage and physiological response. Class III represents moderate-to-severe hemorrhage requiring urgent intervention. ### Class III Hemorrhagic Shock Characteristics | Parameter | Class I | Class II | Class III | Class IV | |-----------|---------|----------|-----------|----------| | **Blood Loss (%)** | <15% | 15–30% | 30–40% | >40% | | **Heart Rate** | <100 | 100–120 | 120–140 | >140 | | **Blood Pressure** | Normal | Normal | Decreased | Severely decreased | | **Respiratory Rate** | 12–20 | 20–30 | 30–40 | >40 | | **Urine Output (mL/kg/hr)** | >30 | 20–30 | 5–15 | Negligible | | **Mental Status** | Normal | Anxious | Confused | Lethargic/unconscious | | **Skin Perfusion** | Normal | Pale | Pale, cold | Pale, cold, clammy | **High-Yield:** Class III shock is the threshold for considering massive transfusion protocol (MTP) activation and immediate operative intervention in trauma. Marked tachycardia (120–140 bpm), tachypnea (30–40/min), and oliguria (5–15 mL/kg/hr) are hallmarks. **Clinical Pearl:** A confused or anxious patient with tachycardia and decreased urine output in the trauma bay signals Class III shock — do not wait for hypotension to develop before escalating care. **Mnemonic:** **CRAM** for Class III — **C**onfused, **R**apid (heart rate 120–140), **A**cute oliguria (5–15 mL/kg/hr), **M**arked tachypnea (30–40).