title: Damage control resuscitation.
abstract: The early recognition and management of hemorrhage shock are among the most difficult tasks challenging the clinician during primary assessment of the acutely bleeding patient. Often with little time, within a chaotic setting, and without sufficient clinical data, a decision must be reached to begin transfusion of blood components in massive amounts. The practice of massive transfusion has advanced considerably and is now a more complete and, arguably, more effective process. This new therapeutic paradigm, referred to as damage control resuscitation (DCR), differs considerably in many important respects from previous management strategies for catastrophic blood loss. We review several important elements of DCR including immediate correction of specific coagulopathies induced by hemorrhage and management of several extreme homeostatic imbalances that may appear in the aftermath of resuscitation. We also emphasize that the foremost objective in managing exsanguinating hemorrhage is always expedient and definitive control of the source of bleeding.
authors: Department of Surgery, Methodist Hospital Indiana University, Indianapolis, IN, USA. Electronic address: tpohlman@iuhealth.org.
authors: Timothy H
authors: TH
authors: Pohlman
authors: Memorial Hospital Trauma Center, Indiana University, South Bend, IN, USA.
authors: Mark
authors: M
authors: Walsh
authors: Memorial Hospital Trauma Center, Indiana University, South Bend, IN, USA.
authors: John
authors: J
authors: Aversa
authors: Department Pharmacy, Methodist Hospital, Indiana University, Indianapolis, IN, USA.
authors: Emily M
authors: EM
authors: Hutchison
authors: LifeLine Critical Care Transport, Indiana University Health, Indianapolis, IN, USA.
authors: Kristen P
authors: KP
authors: Olsen
authors: Department of Surgery, Methodist Hospital Indiana University, Indianapolis, IN, USA.
authors: R
authors: R
authors: Lawrence Reed
mesh_terms: D001778:Blood Coagulation Disorders / Q000628:therapy*; D006801:Humans; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000628:therapy*
keywords: Complications of transfusion; Damage control resuscitation; Hemorrhage-associated coagulopathy; Hemorrhagic shock; Hemostatic resuscitation