When managing the critically ill patient with traumatic hemorrhagic shock, the primary objectives are to stop bleeding, maintain tissue perfusion and oxygen delivery, and limit organ dysfunction.
Pearls to consider when resuscitating these patients include:
In the patient without brain injury, target an SBP of 80 - 100 mm Hg until major bleeding has been controlled.
Limit aggressive fluid resuscitation
Avoid delays in blood and blood component transfusion. Transfuse early. Though the optimal ratio remains controversial, most transfuse PRBCs and FFP in a 1:1 ratio.
Consider point-of-care testing, such as thromboelastography (TEG), to assess the degree of coagulopathy and guide transfusion strategies.
Consider the use of tranexamic acid
References
Bougle A, et al. Resuscitative strategies in traumatic hemorrhagic shock. Annals of Intensive Care 2013; 3.
