Haemorrhagic shock, therapeutic management

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Critical Care

Background:

• Post-traumatic hemorrhagic shock management requires a coordinated prehospital and in-hospital approach.
• Effective treatment necessitates addressing both bleeding sources and physiological derangements.

Purpose of the Study:

• To describe a comprehensive strategy for managing patients in post-traumatic hemorrhagic shock.
• To highlight the integration of prehospital interventions with in-hospital Damage Control Resuscitation.

Main Methods:

• Implementing a "Play and Run" prehospital strategy for rapid transport to a specialized trauma center.
• Utilizing early hemorrhage control measures: tourniquets, pelvic binders, and hemostatic dressings.
• Applying Damage Control Resuscitation principles, including permissive hypotension and correction of hypothermia, acidosis, and coagulopathy.

Main Results:

• Early application of tourniquets, pelvic binders, and hemostatic dressings is crucial for bleeding control.
• Addressing hypothermia, acidosis, and coagulopathy alongside resuscitation is vital.
• Maintaining a target systolic blood pressure of 90 mmHg until hemostasis is achieved is a key objective.

Conclusions:

• A multidisciplinary approach integrating prehospital care with Damage Control Resuscitation improves outcomes in hemorrhagic shock.
• Timely surgical or radiological intervention is essential for definitive hemorrhage control.
• Managing the "triad of death" (hypothermia, acidosis, coagulopathy) is fundamental to successful resuscitation.