Hemorrhagic shock and trauma: brief review and recommendations for management of bleeding and coagulopathy

Abstract

Shock is a state of poor tissue perfusion and the hemorrhagic type is the most common in trauma victims. In this circumstance, strategies are used to guarantee tissue supply of oxygen, as well as to prevent and treat coagulopathies. The fourth edition of the european guideline on management of major bleeding and coagulopathy following trauma was used as a basis, as well as other related publications-in English and Portuguese. Patients with traumatic injuries should be transported quickly to a specialized center. In addition, measures to monitor and maintain coagulation should be started as early as possible and used to guide resuscitation. When indicated, a damage control approach should guide the conduct. The management of hemorrhagic shock is complex and, despite all the knowledge that has been added to the topic in recent years, mortality rates remain high. There is still controversy regarding the best resuscitation strategies and, in order to evolve, it is necessary to establish evidence-based therapeutic approaches with clear objectives.