Hemorrhagic shock, a common cause of postinjury death, should be assumed to be present in any hypotensive trauma patient until proven otherwise. Direct pressure should be used to control obvious external bleeding, and a rapid assessment of hemodynamic status is essential during the primary survey. This includes evaluation of level of consciousness, skin color, and presence and magnitude of peripheral pulses. Attention should be paid to the specifics of heart rate and blood pulse pressure (systolic minus diastolic blood pressure), particularly in previously young, healthy trauma patients ( T§„bJ® 2.4.3i4.).
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