Management of shock in trauma

Shock is failure of the circulatory system to provide the organ perfusion and tissue oxygenation required to meet cellular metabolic demands. Traumatic shock is most commonly associated with haemorrhage, however the trauma patient may present with non-haemorrhagic shock. The ‘lethal triad’ of acute coagulopathy, metabolic acidosis and hypothermia seen in trauma patients is developing the current approach to management of traumatic shock. The ‘ABCDE’ paradigm involves recognition of shock in a primary survey with simultaneous initiation of treatment. Hypotensive resuscitation involves limited volume replacement, during which time poor end-organ perfusion is tolerated, in order to prevent clot dislodgement and re-bleeding. Evidence now suggests that aggressive correction of coagulopathy associated with trauma will help reduce transfusion requirements, decrease bleeding and improve overall outcome. Ratios of packed red blood cells to fresh frozen plasma and platelets closer to 1:1:1 appear to improve outcome and reduce mortality. Damage control resuscitation encompasses key resuscitative strategies including damage control surgery, hypotensive resuscitation and the use of blood products as primary resuscitative fluids to correct coagulopathy. ‘Horizontal’ trauma team assessment with assigned roles including a designated leader, improves outcome when managing the trauma patient.