Abstract
Major hemorrhage results in a switch from aerobic to anaerobic metabolism with a profound depletion of ATP. The primary goal of resuscitation is to revert to aerobic metabolism by addressing three major physiological disturbances, namely, hypoxia, hypoperfusion, and hypothermia. Early intubation and mechanical ventilation are essential interventions although protective lung ventilation should not be employed during the acute stage. Excessive use of clear resuscitation fluids should be avoided, and a massive transfusion protocol using blood and blood products in appropriate ratios must be instituted. Hypothermia is an independent predictor of mortality and rapid core rewarming is essential. Computerized scanning with angiography is the gold standard for the identification of injuries but should only be undertaken if physiology allows. Acute surgical intervention must address only life- or limb-threatening injuries and definitive fracture fixation undertaken at a later stage.
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Muckart, D.J.J., Naidoo, N. (2014). Management of the Polytrauma Patient. In: Di Saverio, S., Tugnoli, G., Catena, F., Ansaloni, L., Naidoo, N. (eds) Trauma Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-5403-5_2
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