Circulation/ Hemorrhage

Circulation is assessed by heart rate, blood pressure, capillary refill time, neck vein distention, etc.. It is important to note that hemorrhaging and the source and cause should be immediately identified to prevent further blood loss and the possibility of hypovolemic shock. It is during this phase of the assessment that large bore intravenous (IV) access be established and blood be obtained for laboratory analysis. A STAT hematocrit or "spun crit" are done immediately to determine the extent of blood loss.

Generally, the victim who has lost blood or sustained open injuries requires fluid resuscitation and/or blood transfusion. Internal hemorrhaging cannot be diagnosed without a computed tomography (CT) scan or ultrasound. Decreases in the hemoglobin or hematocrit readings, in the absence of external hemorrhaging, is often time a good indicator or red flag that the patient is bleeding internally (Trauma.org, 2007).