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Managing Traumatic Hemorrhagic Shock
- 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.