Emerg Med J 30:9-14 doi:10.1136/emermed-2011-201061
  • Original articles

Critical care in emergency department: massive haemorrhage in trauma

  1. Patrick A Nee1,5
  1. 1Intensive Care, Whiston Hospital, Prescot, Merseyside, UK
  2. 2Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
  3. 3NHS Blood and Transplant, Manchester, UK
  4. 4University of Liverpool, Liverpool, UK
  5. 5Liverpool John Moores University, Liverpool, UK
  1. Correspondence to Dr P A Nee, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, Merseyside L35 5DR, UK; patrick.nee{at}
  1. Contributors TM and PAN wrote the original draft, based on their participation in the North West Regional Guideline Development Group on critical bleeding and massive transfusion. KP chaired that group and updated numerous sections following very recent Canadian Consensus Guidelines on massive transfusion. SB wrote the sections related to laboratory science and transfusion practice. AN checked all references for accuracy and assisted with the final draft of the manuscript.

  • Accepted 14 January 2012
  • Published Online First 10 February 2012


Inadequate resuscitation of major haemorrhage is an important cause of avoidable death in severely injured patients. Early recognition of blood loss, control of bleeding and restoration of circulating volume are critical to the management of trauma shock, and transfusion of blood components is a key intervention. Vital signs may be inadequate to determine the need for transfusion, and resuscitation regimens targeting vital signs may be harmful in the context of uncontrolled bleeding. This article addresses current concepts in haemostatic resuscitation. Recent guidelines on the diagnosis and treatment of coagulopathy in major trauma, and the role of component and adjuvant therapies, are considered. Finally, the potential role of thromboelastography and rotational thromboelastometry are discussed.


  • Competing interests None.

  • Provenance and peer review Commissioned; not externally peer reviewed.

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

Related original article: PCT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

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