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Critical care in emergency department: massive haemorrhage in trauma
  1. Tushar Mahambrey1,
  2. Katherine Pendry2,3,
  3. Alexandra Nee4,
  4. Samantha Bonney1,
  5. 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}


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.

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  • Competing interests None.

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