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Fixed Volume or Fixed Pressure: A Murine Model of Hemorrhagic Shock
Published on: June 6, 2011
Traumatic hemorrhagic shock: advances in fluid management.
1Department of Emergency Medicine, Mount Sinai School of Medicine, Elmhurst Hospital Center, New York, NY, USA.
Emergency Medicine Practice
|December 15, 2011
Summary
Damage control resuscitation (DCR) is a new paradigm for treating traumatic hemorrhagic shock. Key findings include using tranexamic acid, massive transfusion protocols, avoiding large crystalloid volumes, and permissive hypotension.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Critical Care
Background:
- Concerns exist regarding aggressive crystalloid resuscitation in traumatic hemorrhagic shock.
- Traditional ED protocols for shock resuscitation are being re-evaluated.
- A shift towards damage control resuscitation (DCR) is emerging.
Purpose of the Study:
- To review advances in traumatic hemorrhagic shock resuscitation.
- To discuss the new paradigm of damage control resuscitation (DCR).
- To cover resuscitation goals, fluid choices, coagulopathy, TBI management, and pharmacologic treatments.
Main Methods:
- Review of recent literature on traumatic hemorrhagic shock management.
- Analysis of current emergency department (ED) resuscitation protocols.
- Discussion of key components of damage control resuscitation (DCR).
Main Results:
- Tranexamic acid (TXA) is recommended for uncontrolled hemorrhage (Class I).
- Massive transfusion protocols (MTP) with fixed blood product ratios are advised (Class II).
- Avoidance of large-volume crystalloid resuscitation (Class III) and use of permissive hypotension (Class III) are recommended.
- Initial fluid choice has not demonstrated impact on trauma outcomes (Class I).
Conclusions:
- Damage control resuscitation (DCR) represents a paradigm shift in managing traumatic hemorrhagic shock.
- Evidence supports tranexamic acid, MTP, limited crystalloids, and permissive hypotension.
- Further research may clarify optimal fluid strategies in trauma resuscitation.
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