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Initial assessment and management
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Extent of traumatic haemorrhage assessed
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Patient in shock with identified source of bleeding treated immediately
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Patient in shock with unidentified source of bleeding sent for further investigation
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Coagulation, haematocrit, serum lactate, base deficit assessed
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Antifibrinolytic therapy initiated
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Patient history of anticoagulant therapy assessed (vitamin K antagonists, antiplatelet agents, oral anticoagulants)
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Resuscitation
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Systolic blood pressure of 80–90 mmHg achieved in absence of traumatic brain injury
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Measures to achieve normothermia implemented
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Target haemoglobin level 7–9 g/dl achieved
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Surgical intervention
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Abdominal bleeding control achieved
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Pelvic ring closed and stabilised
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Peritoneal packing, angiographic embolisation or surgical bleeding control completed in haemodynamically unstable patient
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Damage control surgery performed in haemodynamically unstable patient
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Local haemostatic measures applied
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Thromboprophylactic therapy recommended
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Coagulation management
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Coagulation, haematocrit, serum lactate, base deficit, calcium reassessed
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Target fibrinogen level 1.5–2 g/l achieved
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Target platelet level achieved
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Prothrombin complex concentrate administered if indicated due to vitamin K antagonist, oral anticoagulant or evidence from viscoelastic monitoring
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