The severity of bleeding should be based on all of the following findings, EXCEPT:

• A. clinical signs and symptoms.
• B. poor general appearance.
• C. the mechanism of injury.
• D. systolic blood pressure.

Answer: (D)

The amount of bleeding is judged by how the patient looks and behaves and by what caused the injury, not by a single blood pressure reading. Clinical signs and symptoms reveal how well perfusion is maintained and whether blood loss is ongoing (for example, dizziness, fainting, rapid or weak pulse, sweating). Poor general appearance, such as pallor or cool, clammy skin, also indicates compromised perfusion from blood loss. The mechanism of injury helps anticipate the likelihood and potential extent of bleeding based on the forces involved (high‑energy trauma or penetrating wounds can produce concealed hemorrhage even if external signs are mild). Systolic blood pressure, while important, is a late or unreliable sole indicator of bleeding severity because the body can compensate early on, keeping BP normal despite significant blood loss. Therefore, bleeding severity is best assessed using signs and symptoms, general appearance, and mechanism of injury, not systolic blood pressure alone.