An initial approach to the bleeding patient

Mortality from uncontrolled hemorrhage and hemorrhagic shock occurs early. Initial resuscitation strategies to reduce hemorrhage associated death demand a multidisciplinary approach emphasizing three main principles (1) early hemorrhage control (2) rapid identification of cavitary hemorrhage and (3) early and aggressive balanced blood product resuscitation in addition to mandatory resuscitation maneuvers including airway control. These strategies address the overarching pathology of cardiovascular collapse secondary to hypovolemia, as well as the underlying pathologies of resuscitation induced coagulopathy and the acute coagulopathy of trauma. Approaches and techniques used during the initial assessment of the patient in hemorrhagic shock are discussed and include: rapid sequence intubation, tourniquet use, pelvic binder application, and venous access. Following emergent stabilization, localizing the source of hemorrhage is critical. Current diagnostic modalities including plain film radiology, the focused assessment with sonography for trauma (FAST), echocardiography, and peritoneal aspiration and lavage are discussed with respect to technique and application.