Goal

Determine when to stop administration of blood products. It may be difficult to determine when to stop resuscitation and transition to maintenance monitoring and care. Patients may have abnormal vital signs for many reasons. Obtain teleconsultation if targets are not being met and/or trending in the wrong direction.

- Minimum: Identify clinical stabilization through ongoing monitoring and examination.

Slowing heart rate, palpable peripheral pulses, brisk capillary refill, warming extremities, improving mental status (if no brain injury), slowing/cessation of coagulopathic bleeding (wounds and/or IV site bleeding).

- Better: In addition to minimum, recognize improved vital signs and objective criteria.
  - SBP at goal
    - - Goal SBP is approximately 100mmHg if resuscitating with blood products (maintain mild hypotension until definitive bleeding control).
    - - In patients with traumatic brain injury, goal SBP is greater than 110mmHg.
    - - If unable to resuscitate with blood products, a lower blood pressure goal of SBP from 80– 90mmHg is acceptable.
  - Oxygen saturation (Spo2) at least 90% (SpO2 >96% is not necessary),32 fraction of inspired oxygen (Fio2) required should be less than 50%
  - Temperature greater than 95ºF (35ºC)
  - UO greater than 30mL/h or greater than 0.5mL/kg/h o
- Best: In addition to minimum and better, confirm that hemorrhagic shock is resolving, using the following laboratory values:
  - Hemoglobin concentration greater than 8.0g/dL
  - Hematocrit greater than 27%
  - Lactate concentration less than 2.5mmol/L
  - Base deficit less than 4 (base excess greater than −4)

Note: Improving trends are as important as meeting absolute goals when assessing response.

If laboratory values do not improve or trend in the wrong direction for two or more different values, either additional resuscitation and/or hemorrhage control interventions are needed or the injury is not survivable given resources and capabilities available. Consider teleconsultation. Expectant management may be appropriate in some circumstances.