Management of Circulatory Compromise In Trauma Patients: Controversies and Solutions

Abstract

Massive hemorrhage due to trauma can lead to circulatory compromise that may results in death of the victim. In most of the instances it is preventable if prompt resuscitative measures are taken. The circulatory compromise leading to shock may also occur due to other causes in a trauma victim. This includes obstructive, distributive and cardiogenic shocks. All these can lead to a state of hypoperfusion and compromised oxygen delivery at cellular level. This results in anaerobic metabolism that cannot sustain life for long and finally the death of the cells takes place. This finally end up in a multi-organ failure. Many a time more than one type of shock exists in a trauma victim. However, hypovolemia due to blood loss remains on the top of the list.¹ The pathophysiological changes due to blood loss varies depending upon the nature of the insult and time elapsed since the injury. A more tailored approach is required to address the circulatory insufficiency for each trauma victim. It takes precedence over a stereotype formula based approach. ²