Identification and resuscitation of the trauma patient in shock

Trauma is a major source of morbidity and mortality in the United States and world-wide. When analyzed from a global perspective, the World Health Organization estimates that over 5 million people died of traumatic injury in the year 2000, accounting for 9% of global mortality and 12% of the global disease burden [1]. In the United States, traumatic injury is the fifth most frequent cause of death, with roughly 10% of the population suffering from some type of traumatic injury in any given year [2]. Although trauma impacts all age groups, it has an especially significant impact on the younger patient demographic, with roughly 50% of those who die being between 15 and 44 years of age [3]. Regardless of the mechanism of injury, hemorrhage is a leading cause of death following trauma [4-7]. Injury-induced hemorrhage accounts for the largest proportion of mortality within the first hour of trauma center care, causes 50% of injury-associated death within the first 24 hours of trauma care, and claims more lives than any other injury-induced pathology within the first 48 hours of care [7,8]. Moreover, hemorrhage-induced hypotension in trauma patients is predictive of greater than 50% mortality. Unlike more insidious processes, traumatic hemorrhagic shock kills quickly, with the bulk of its victims succumbing within the first few hours of emergency department arrival [9]. Though hemorrhage remains the most common etiology of trauma-related shock, other forms of shock such as obstructive, cardiogenic, or neurogenic may occur and need to be considered as well. This article focuses on rapid diagnosis and treatment of the patient suffering from trauma-related shock, including early identification of patients at risk for occult hypoperfusion. Resuscitation strategies (delayed resuscitation, damage control resuscitation), end points of resuscitation, and the role of blood products and pro-coagulants for resuscitation are discussed.