title: Hypovolemic shock resuscitation.
abstract: Several changes in the way patients with hemorrhagic shock are resuscitated have occurred over the past decades, including permissive hypotension, minimal crystalloid resuscitation, earlier blood transfusion, and higher plasma and platelet-to-red cell ratios. Hemostatic adjuncts, such as tranexamic acid and prothrombin complex, and the use of new methods of assessing coagulopathy are also being incorporated into resuscitation of the bleeding patient. These ideas have been incorporated by many trauma centers into institutional massive transfusion protocols, and adoption of these protocols has resulted in improvements in mortality and morbidity. This article discusses each of these new resuscitation strategies and the evidence supporting their use.
authors.affiliation: Division of Trauma, Surgical Critical Care, and Burns, Department of Surgery, University of California San Diego School of Medicine, San Diego, CA 92103, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Kobayashi
authors.forename: Todd W
authors.initials: TW
authors.lastname: Costantini
authors.forename: Raul
authors.initials: R
authors.lastname: Coimbra
mesh_terms: D001778:Blood Coagulation Disorders / Q000175:diagnosis; D001803:Blood Transfusion / Q000379:methods; D005440:Fluid Therapy; D006801:Humans; D012769:Shock / Q000145:classification / Q000503:physiopathology / Q000628:therapy*; D012771:Shock, Hemorrhagic / Q000628:therapy; D013916:Thrombelastography