Absence of a tachycardic response to intraperitoneal hemorrhage

Five cases of intraperitoneal hemorrhage associated with hypotension and the lack of a tachycardic response are presented. All patients were young, previously healthy women without a history of myocardial disease. None of our patients fits into the category of "irreversible shock." Although relative bradycardia associated with hypotension is often considered a preterminal event, each of our patients recovered after laparotomy. In hypovolemic shock due to intraperitoneal bleeding, the lack of a tachycardic response may occur earlier and perhaps more often than has been suggested, and may delay definitive treatment by confusing the clinical picture. Orthostatic vital signs may be helpful in distinguishing those with true hypovolemia.