Goal

Recognize patients with traumatic hemorrhage who will benefit from implementing DCR early to decrease mortality.

Initial Survey:

Recognize hemorrhagic shock based on rapid examination and recognition of severe injury pattern.

If initial survey does not indicate severe blood loss, continue assessment, check vital signs, and assess for signs of shock. Recognize hemorrhagic shock on the basis of presence of severe traumatic injury associated with the following:

Advanced Capabilities

When additional laboratory capability and/or ultrasound are available, confirm evidence of hemorrhagic shock using laboratory and/or imaging studies. Do not delay initiating DCR if hemorrhagic shock is clinically suspected: Begin treating immediately once hemorrhagic shock is suspected.

Predictors associated with massive transfusion (i.e. more than 10 units of blood in the first 24 hours) may help identify patients who will require massive transfusion. The more predictors present, the higher the risk of massive transfusion.13–22