First identifier of hemmorhagic shock?

[SummitRN, BSN, RN]

Internal bleed, which shows first?

A: restlessness and increased HR

or

B: apathy and decreased urinary output

I'm thinking they want B (apathy would come before restlessness) but I honestly think that it's a bad question because increased HR would show before or concurrently decreased urinary output. Thoughts?

(this is an example question so I don't have the right answer or a rationale, but it got me wondering!)

[Rosinka]

I would choose A, because the first thing you do is you check your ABC's and vitals and then the rest. For urinary output - you have to monitor pt for I&O to know that the pt is having decreased urinary output.

[link51411]

I work in the Neuro ICU and its A. people always get upset, bad headache, etc, or restlessness. and if your bleeding your HR increases. people eventually develop apathy, fall asleep and dont wake up if a bleed is untreated.

[SummitRN, BSN, RN]

Rosinka: scenario is a postop (GI) bleed

I dunno. I like the A explanation because the I&O would be a delayed finding even though the urinary output would be a prompt effect. Unless it was a SLOOOOW bleed?

(Coming from EMS I keep on making these bad assumptions that everything happens slowly inside )

[NuteRN]

I'd pick (A). Restlessness would be because of low O2 sats due to blood loss, Heart rate would increase as blood pressure decreases.

[P-medic2RN]

A is the correct answer. But don't forget those on Beta blockers are not going to have an increased heart rate.

[kponderRN]

tachycardia is the first indicator