Management of hemorrhagic shock in trauma patient

Pr Jacques Duranteau

Département d’Anesthésie-Réanimation Chirurgicale

Hôpital de Bicêtre

Resuscitation of hemorrhagic shock requires the early identification of potential bleeding sources followed by prompt action to minimize blood loss, to restore tissue perfusion and to achieve hemodynamic stability. Patients presenting with hemorrhagic shock and an unidentified source of bleeding should undergo immediate further assessment as appropriate using focused sonography and computed tomography. Patients with hemorrhagic shock require an immediate bleeding control by a surgical control or by an angiographic embolization. A damage control surgical approach is essential in the severely injured patient. Pelvic ring disruptions should be closed and stabilized, followed by appropriate angiographic embolization or surgical bleeding control, including packing. The goal of the initial management is to restore perfusion pressure with fluid resuscitation. The use of vasopressors is justified when fluid resuscitation is not able to restore blood pressure. In addition, vasopressors could avoid the deleterious consequences of a too aggressive fluid administration. Blood product transfusion is combined to restore oxygen delivery and to correct biological hemostasis. The indications of antifibrinolytic are not yet determined. The use of rFVIIa can be considered if major bleeding in blunt trauma persists despite standard attempts to control bleeding and best practice use of blood components.

Key words:

Hemorrhagic shock - oxygen – fluid resuscitation - vasopressors – transfusion - activated factor VII - interventional radiology