The initial approach to resuscitation of traumatic hemorrhagic shock entails (1) restoring intravascular volume with a high ratio of blood products to maintain oxygen delivery and tissue perfusion, (2) treating the coagulopathy, and (3) managing complications related to shock and MT, including metabolic acidosis and hypothermia. For more than a decade, trauma centers have adapted the practice of initial resuscitation with hemostatic components, such as plasma and platelets. This strategy for treating massive hemorrhage was pioneered from experience and knowledge gained during combat in Afghanistan and Iraq; it involves limiting the total volume of crystalloid administered and replacing intravascular volume with pRBCs and plasma in a ratio approaching 1:1. The overall goal is to provide fluids with oxygen-carrying capacity and hemostatic capabilities while avoiding the acute coagulopathy associated with major trauma and blood loss, which has been shown to increase mortality rates. Permissive hypotension is a resuscitation strategy at some trauma centers to minimize further bleeding at the site of injury. The goal is to not "pop the clot" by tolerating a low mean arterial pressure. Further studies are needed to validate the clinical benefits of this approach.

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