UMEM Educational Pearls

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


Bougle A, et al. Resuscitative strategies in traumatic hemorrhagic shock. Annals of Intensive Care 2013; 3.