In hemorrhagic shock, significant blood loss leads to decreased circulating volume and impaired tissue perfusion. The body responds with sympathetic activation causing tachycardia and peripheral vasoconstriction, resulting in pale, cold, and clammy skin. This compensatory mechanism aims to maintain blood flow to vital organs. Warm, flushed skin is typically seen in distributive shock, not hemorrhagic shock. Bradycardia and hypertension are late or atypical signs. Thus, pale, cold skin with tachycardia is a key clinical indicator of hemorrhagic shock in a trauma patient with hypotension.

Reference: Trauma, Feliciano, Moore, Mattox, 8th Edition.