PT - JOURNAL ARTICLE AU - Tushar Mahambrey AU - Katherine Pendry AU - Alexandra Nee AU - Samantha Bonney AU - Patrick A Nee TI - Critical care in emergency department: massive haemorrhage in trauma AID - 10.1136/emermed-2011-201061 DP - 2013 Jan 01 TA - Emergency Medicine Journal PG - 9--14 VI - 30 IP - 1 4099 - http://emj.bmj.com/content/30/1/9.short 4100 - http://emj.bmj.com/content/30/1/9.full SO - Emerg Med J2013 Jan 01; 30 AB - 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.