<p> The cardiovascular system is designed to carry out one crucial job: keep blood flowing between the lungs and the peripheral tissues.  Hemorrhage simply means bleeding. – Bleeding can range from a “nick” to a capillary while shaving, to a severely spurting artery from a deep slash with a knife, to a ruptured spleen from striking the steering column during a car crash. – External bleeding can usually be easily controlled by using direct pressure or a pressure bandage. – Internal bleeding is usually not controlled until a surgeon locates the source and sutures it closed.  The assessment of any patient begins with a good scene size-up and proceeds to your general impression and initial assessment. – Once the scene is deemed safe to enter, you will need to take the appropriate level of BSI precautions. – Depending on the severity of bleeding and your general impression, this will entail gloves, mask, eyeshield, and, when the patient is very bloody or blood is spurting, a gown.  In case of hemorrhage, the issue is not whether the patient will be transported, but rather how fast the transport decision should be made and where the patient should be taken for definitive care.  Hypoperfusion occurs when the level of tissue perfusion decreases below normal. – Early decreased tissue perfusion may result in subtle changes, such as aberrant mental status, long before a patient’s vital signs (that is, BP, pulse, respiratory rate) appear abnormal. – Shock refers to a state of collapse and failure of the cardiovascular system that leads to inadequate circulation, creating inadequate tissue perfusion.  As with any patient, airway and ventilatory support take top priority when treating a patient with suspected shock.  If a patient is suspected to be in shock, transport is inevitable; the questions to be asked are simply when and where. – Consideration for the priority of the patient and the availability of a regional trauma center should be your concerns, and local transport protocols may specifically deal with these issues. – Patients who have suspected shock, whether compensated or decompensated, will benefit from early surgical intervention and should be transported to a facility with those capabilities.  Prevention of shock and its deadly effects begins with your immediate assessment of the MOI, initial assessment findings, and the patient’s clinical picture. – Be alert, and search for early signs of shock.</p>