Damage-control resuscitation in traumatic haemorrhagic shock

This is class III to IV haemorrhagic shock from intra-abdominal bleeding, and the priority is simultaneous resuscitation and the control of haemorrhage, because the lethal triad of acidosis, hypothermia and coagulopathy kills the bleeding patient if it is allowed to develop.^[1]

Activate the massive transfusion protocol now and assemble the trauma team. Apply the primary survey with high-flow oxygen and control of catastrophic external haemorrhage. Establish large-bore intravenous access and send bloods including a crossmatch, coagulation and a lactate. Resuscitate with blood products in a balanced ratio approaching a 1:1:1 plasma-to-platelets-to-red-cells ratio, rather than crystalloid, which dilutes clotting factors and worsens coagulopathy; the PROPPR trial supports the balanced ratio for earlier haemostasis.^[2] Give tranexamic acid early — a 1 gram intravenous bolus then a 1 gram infusion over eight hours — within three hours of injury (benefit when given within 3 hours; possible harm beyond), since it reduces mortality from traumatic bleeding;^[1][3]

Definitive haemorrhage control is the decisive intervention and it is pursued in parallel. A FAST at the bedside confirms intra-abdominal bleeding; in the unstable blunt-trauma patient with a positive FAST and haemorrhagic shock, the destination is the operating theatre for a damage-control laparotomy, not the computed tomography scanner. If an interventional radiology service is available and the patient is a candidate, pelvic embolisation is considered for pelvic bleeding. The resuscitation continues into theatre and the intensive care unit, where the lethal triad is corrected and the physiology restored before definitive surgical repair.^[1]