# Estimating Blood Loss



## Rin (Aug 23, 2014)

How do you?

Anyone have any handy size comparisons for estimating the volume of blood puddles?  Especially on various surfaces like non-porous vs. carpet vs. upholstery.

Or do you just eyeball it and say, "Yeah, that looks significant."


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## DesertMedic66 (Aug 23, 2014)

I pretty much just eyeball it and make a quick guess. Ill get the approximate size for the hospital.

Way back in EMT school we bought fake blood with the same thickness as real blood. We filled different sizes of bags (100ml, 250ml, 500ml, and 1L) and then drained the bags on the ground. Its been so long that I don't remember the sizes anymore.


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## NPO (Sep 5, 2014)

The same way you estimate height and weight.

Guess.

You'll get better at it. Take into consideration the ground surface. Dirt, carpet, grass etc all obsorb blood, making it look like less than there actually is. Concrete, tile, etc spread it out.


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## Jason (Sep 5, 2014)

Hey,
Yes ... it tends to be a lot of "Yeah, that looks significant."
However, studies show that EMS and Physicians (ER or Trauma) are generally not accurate in estimating blood loss at a look.  Which I suppose is not a good thing.  
A previous study:


*87% underestimated the quantity of blood*
9% overestimated
4% guessed the exact amount
Experience or credentialing level did not matter
Only 8% of the subjects were within 20% of the actual volume, and an additional 19% were within 50%.  The median guess for the 2100cc loss group was only 700cc!

This website shows different blood losses:
https://crana.org.au/files/pdfs/Gui...on_of_Blood_Loss_at_Obstetric_Haemorrhage.pdf

Rin, your question is excellent ... and from material I've read ... it seems that experience is the best teacher.  I've heard many providers EMS and Physicians alike say:  minimal, moderate, or severe blood loss.  It doesn't say an amount, but does kinda give you a pretty good idea.  
Of course, one could look at general Patient appearance and vital signs and use best description to treat the Patient and give report.


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## jwk (Sep 5, 2014)

It's always a guess, even in surgery for the most part.  For pediatric cases, we can weigh sponges and keep a very close eye on blood in the suction canisters, so those estimates are pretty good.  Being 100cc off in an adult is no big deal, but that same 100cc in a 10kg baby is a really big deal.


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## Carlos Danger (Sep 6, 2014)

jwk said:


> It's always a guess, even in surgery for the most part.  For pediatric cases, we can weigh sponges and keep a very close eye on blood in the suction canisters, so those estimates are pretty good.  Being 100cc off in an adult is no big deal, but that same 100cc in a 10kg baby is a really big deal.



Or just ask the surgeon.....they always know.


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## Tigger (Sep 7, 2014)

I've always wondered why I matters. If it looks like there's a lot of blood on the ground and the patient isn't doing well, then it's a lot blood. If appearance, mentation, and vital signs are still solid it's either not a lot of blood or the patient is compensating and you need to treat appropriately. Not too tough. 

Had a suicide attempt last night that involved a knife and a wrist. The cops were yelling at us to expedite (lol) and while there was blood all over the place, it was on asphalt and the patient was entirely stable.


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## Rin (Sep 7, 2014)

"Expedite already!" Lol

The minimal/moderate/severe scale sounds reasonable.  I must just have this nightmare that an ER doc is going to ask me how much blood was lost down to the nearest tenth of a cc lol


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## DesertMedic66 (Sep 7, 2014)

Rin said:


> "Expedite already!" Lol
> 
> The minimal/moderate/severe scale sounds reasonable.  I must just have this nightmare that an ER doc is going to ask me how much blood was lost down to the nearest tenth of a cc lol


Doc, it looked like a slaughter house in there...


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## Carlos Danger (Sep 7, 2014)

Rin said:


> The minimal/moderate/severe scale sounds reasonable.



It's more than reasonable. Any more specific than that and you'd simply be guessing. Even surgeons aren't good at estimating EBL.

And none of it really even matters anyway.....it's the clinical presentation that dictates management.


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## jwk (Sep 7, 2014)

jwk said:


> It's always a guess, even in surgery for the most part.  For pediatric cases, we can weigh sponges and keep a very close eye on blood in the suction canisters, so those estimates are pretty good.  Being 100cc off in an adult is no big deal, but that same 100cc in a 10kg baby is a really big deal.


I always double the surgeon's estimate, and then add a fudge factor.    Seriously - there can be 2 liters of blood in the suction canister and they'll say the EBL is 500 and actually argue about it.


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## Rialaigh (Sep 21, 2014)

Tigger said:


> I've always wondered why I matters. If it looks like there's a lot of blood on the ground and the patient isn't doing well, then it's a lot blood. If appearance, mentation, and vital signs are still solid it's either not a lot of blood or the patient is compensating and you need to treat appropriately. Not too tough.
> 
> Had a suicide attempt last night that involved a knife and a wrist. The cops were yelling at us to expedite (lol) and while there was blood all over the place, it was on asphalt and the patient was entirely stable.



This entirely, especially when the flight crew is asking. It's either enough to make a difference or it's an amount that doesn't matter.


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