{ "schemaVersion": 2, "eyebrow": "Trauma and Critical Care", "title": "Hemorrhagic Shock", "summary": "Hemorrhagic shock demands immediate recognition, mechanical hemorrhage control, rapid blood-product delivery, and parallel definitive operative or endovascular management. This review emphasizes time-sensitive actions, reassessment, trauma-specific diagnostic limitations, and important evidence gaps in resuscitation targets and adjunctive pharmacotherapy.", "seoDescription": "Point-of-care review of hemorrhagic shock recognition, hemorrhage control, blood-product resuscitation, monitoring, and definitive trauma care.", "clinicalQuestion": "How should physicians recognize and resuscitate hemorrhagic shock while expediting definitive hemorrhage control?", "specialty": "Emergency Medicine, Trauma Surgery, Critical Care", "audience": "U.S. physicians and medical trainees", "tags": [ "hemorrhagic shock", "trauma resuscitation", "massive hemorrhage protocol", "massive transfusion", "damage-control resuscitation", "hemorrhage control" ], "keyTakeaways": [ "Treat suspected hemorrhagic shock as a time-critical hemorrhage-control emergency; clinical assessment, vital signs, shock index, end-tidal carbon dioxide, and point-of-care lactate may support recognition. [13]", "Control external bleeding immediately with pressure dressings, hemostatic wound packing, tourniquets, pelvic binders for suspected pelvic fracture, or junctional measures as anatomically appropriate. [13]", "Activate the institutional major hemorrhage protocol early and deliver initial blood components without delay; ACS Trauma Quality Improvement Program guidance cited in a registry analysis advises no more than 10 minutes from protocol activation to initial component delivery. [15]", "Reassess continuously during transfusion and pursue definitive operative or interventional radiology control in parallel; resuscitation cannot substitute for source control. [13][15]", "Traumatic brain injury complicates permissive-volume strategies because cerebral resuscitation prioritizes maintenance of adequate perfusion while hemorrhage resuscitation addresses intravascular volume loss. [24]" ], "sections": [ { "id": "recognition-and-priorities", "eyebrow": "Initial Assessment", "heading": "Recognize hemorrhagic shock and act before confirmation", "intro": "Diagnostic uncertainty should not delay hemorrhage control or resuscitation.", "paragraphs": [ "Hemorrhagic shock is primarily a clinical diagnosis in an actively bleeding patient. Use serial physiologic assessment rather than a single vital-sign snapshot: blood pressure, heart rate, shock index, end-tidal carbon dioxide when available, and point-of-care lactate are identified as useful components of prehospital recognition. [13]", "Missed major hemorrhage has meaningful consequences. In a 947-patient prehospital study, major hemorrhage was missed in 41 of 138 patients; missed diagnosis was associated with a threefold higher mortality risk despite admission to a major trauma center. Penetrating mechanism and major abdominal injury independently increased the odds of a missed diagnosis. [12]", "Perform resuscitation and localization simultaneously. Obtain large-bore intravenous access promptly; the prehospital blood transfusion guideline prefers intravenous access of 18-gauge or larger. [13]" ], "bullets": [ "Escalate concern when mechanism, examination, or trajectory suggests concealed bleeding despite initially nondiagnostic physiology; penetrating injury and major abdominal injury are particularly vulnerable to underrecognition. [12]", "Use repeated bedside reassessment after each intervention rather than assuming that an initial response represents durable control. [13]" ], "subsections": [], "table": { "caption": "Recognition features and immediate actions supported by available trauma literature. [12][13]", "columns": [ "Finding or context", "Clinical implication", "Immediate action" ], "rows": [ [ "Abnormal vital signs, shock index, end-tidal carbon dioxide, or point-of-care lactate", "Supports rapid recognition of life-threatening hemorrhagic shock but does not replace clinical judgment. [13]", "Control hemorrhage, obtain vascular access, and activate escalation pathways. [13]" ], [ "Penetrating mechanism or major abdominal injury", "Associated with missed prehospital major hemorrhage. [12]", "Maintain a low threshold for hemorrhage-focused evaluation and destination/trauma-team escalation. [12]" ], [ "Diagnostic uncertainty with suspected active bleeding", "Clinical diagnosis can be delayed; missed major hemorrhage is associated with increased mortality. [12]", "Treat uncertainty as an indication for serial assessment and early resuscitative preparation. [12][13]" ] ] } }, { "id": "hemorrhage-control", "eyebrow": "Source Control", "heading": "Control bleeding before physiology deteriorates further", "intro": "Use anatomy-directed measures immediately while arranging definitive control.", "paragraphs": [ "For severe external wounds, use pressure dressings and wound packing, preferably with hemostatic products. Use tourniquets for substantial extremity hemorrhage; use wound packing or junctional tourniquets for junctional bleeding. Apply a pelvic binder when pelvic fracture is suspected. [13]", "Definitive hemorrhage control must occur in parallel with component resuscitation. A registry-based analysis emphasizes that reducing time to definitive control is modifiable, while also cautioning that selected patients may require enough characterization of bleeding pathophysiology to guide the appropriate intervention. [15]" ], "bullets": [ "Assign an explicit hemorrhage-control plan: external control, operative management, interventional radiology, or a combination. [13][15]", "Avoid allowing imaging or laboratory completion to become a substitute for timely source-control escalation in an unstable patient; the supplied evidence supports simultaneous life-saving interventions and timely transfusion. [15]" ], "subsections": [], "table": { "caption": "", "columns": [], "rows": [] } }, { "id": "blood-product-resuscitation", "eyebrow": "Resuscitation", "heading": "Use early blood products and protocolized delivery", "intro": "Resuscitate while controlling hemorrhage, with continuous response assessment.", "paragraphs": [ "Major hemorrhage protocols are intended to standardize rapid delivery of blood components and hemostasis-directed products during active resuscitation. In the cited trauma registry report, ACS Trauma Quality Improvement Program guidance advised a maximum 10-minute interval from major hemorrhage protocol activation to delivery of the initial blood components. [15]", "Delay matters: in that registry analysis, each minute of delay to blood-component delivery was associated with higher odds of 30-day mortality (adjusted odds ratio 1.05; 95% CI, 1.01-1.09). This observational association supports operational urgency but does not establish a specific component ratio, volume target, or causally proven minute-by-minute effect. [15]", "The 2025 prehospital clinical practice guideline supports early resuscitation with blood products for hemorrhagic shock regardless of etiology. Monitor response continuously during product administration; the guideline notes that reassessment of vital signs and clinical response can mitigate over-resuscitation from multiple prehospital units. [13][14]" ], "bullets": [ "Activate the institutional major hemorrhage protocol early when ongoing bleeding and shock are suspected, rather than waiting for conventional laboratory confirmation. [15]", "Warm blood products and ensure warming-device calibration when used; the prehospital guideline includes warming equipment as a programmatic and operational consideration. [13]", "Use local massive-transfusion protocols for product selection, component sequence, coagulation testing, calcium replacement, and endpoint targets; these details are not specified in the supplied sources. [13][15]" ], "subsections": [ { "heading": "Fluids and vasoactive adjuncts", "paragraphs": [ "The available evidence does not support a universal crystalloid volume, blood-component ratio, blood-pressure target, or vasopressor regimen. A historical experimental report found that early Ringer lactate resuscitation after head injury with uncontrolled hemorrhagic shock worsened cerebral hemodynamics; this should be interpreted as mechanistic evidence rather than a current clinical protocol. [11]", "In a randomized trial summarized in the search results, low-dose arginine vasopressin during trauma hemorrhagic-shock resuscitation reduced blood-product requirements. The available result does not provide a dose, eligibility criteria, mortality effect, or guideline endorsement; therefore, it should not displace blood-product resuscitation and hemorrhage control. [16]" ], "bullets": [ "Do not infer a recommended vasopressin dose or routine indication from the supplied trial summary. [16]", "Do not use nitroglycerin in hemorrhagic shock; its labeling describes overdose hypotension as mediated by venodilation and arterial hypovolemia, requiring supportive volume restoration rather than a specific antidote. [4]" ] } ], "table": { "caption": "Operational priorities in active hemorrhagic-shock resuscitation. [13][15]", "columns": [ "Priority", "Action", "Monitoring or decision point" ], "rows": [ [ "Hemorrhage protocol", "Activate early and target delivery of initial blood components within 10 minutes of activation, consistent with cited ACS TQIP guidance. [15]", "Track activation-to-product time as a modifiable process measure. [15]" ], [ "Blood-product administration", "Begin early blood-product resuscitation while pursuing source control. [13][14]", "Continuously reassess vital signs and clinical response to reduce risk of over-resuscitation. [13]" ], [ "Definitive control", "Coordinate operative and/or interventional radiology management in parallel with transfusion. [15]", "Prioritize reduction in time to control while allowing selected diagnostic clarification when it changes the intervention. [15]" ] ] } }, { "id": "monitoring-and-reassessment", "eyebrow": "Monitoring", "heading": "Use trajectory, not isolated measurements, to guide escalation", "intro": "Persistent instability indicates ongoing bleeding or inadequate control until proved otherwise.", "paragraphs": [ "Continuously reassess physiologic response during blood-product administration. The prehospital guideline specifically emphasizes ongoing monitoring of response to blood products and repeated vital-sign assessment. [13]", "A transient improvement after fluids or blood does not establish hemostasis. Escalate source-control efforts when instability recurs or fails to improve, and reassess for external, thoracic, abdominal, pelvic, junctional, or vascular bleeding based on mechanism and examination. The importance of timely definitive control is supported by trauma registry data. [13][15]", "The supplied sources do not establish validated universal targets for shock index, lactate clearance, end-tidal carbon dioxide, blood pressure, hemoglobin, coagulation assays, or urine output in hemorrhagic shock. Use institution-specific trauma and massive-transfusion pathways for target-based monitoring." ], "bullets": [ "Document response after hemorrhage-control maneuvers and each blood-product interval. [13]", "Treat recurrent hemodynamic deterioration as a trigger for renewed search for ongoing hemorrhage and reassessment of the definitive-control plan. [13][15]" ], "subsections": [], "table": { "caption": "", "columns": [], "rows": [] } }, { "id": "traumatic-brain-injury", "eyebrow": "Special Population", "heading": "Modify the resuscitation strategy when traumatic brain injury is present", "intro": "Avoid treating traumatic brain injury and uncontrolled bleeding as interchangeable physiologic problems.", "paragraphs": [ "Concurrent traumatic brain injury creates a competing resuscitation priority. Hemorrhagic-shock resuscitation seeks restoration of lost blood volume, whereas traumatic brain injury management prioritizes maintenance of adequate cerebral perfusion. [24]", "The supplied evidence does not define a specific blood-pressure target or fluid regimen for patients with combined traumatic brain injury and hemorrhagic shock. Early Ringer lactate resuscitation in an older experimental report worsened cerebral hemodynamics in head injury with uncontrolled hemorrhagic shock, reinforcing the need to avoid extrapolating simplified fluid strategies to this population. [11]" ], "bullets": [ "In combined traumatic brain injury and hemorrhage, expedite hemorrhage control and coordinate trauma, anesthesia, and neurosurgical priorities; use current institutional neurotrauma protocols for perfusion targets.", "Do not apply permissive-volume or hypotension strategies without accounting for cerebral-perfusion risk; a precise threshold is not supported by the supplied sources. [11][24]" ], "subsections": [], "table": { "caption": "", "columns": [], "rows": [] } }, { "id": "systems-of-care", "eyebrow": "Implementation", "heading": "Build a system that minimizes time to blood and control", "intro": "Hemorrhagic-shock outcomes depend on coordinated operational performance.", "paragraphs": [ "Prehospital blood-transfusion programs require protocols for recognition, vascular access, transfusion procedure, adverse-reaction management, storage and transport, documentation, training, and quality review. The guideline recommends regular case review of prehospital transfusions, consideration of each transfusion as a sentinel event, outcome tracking, blood-product utilization analysis, and wastage monitoring. [13]", "For receiving hospitals, measure activation-to-first-product time and time to definitive control. The cited registry study identifies blood-component delay as a potentially modifiable process associated with mortality, while recognizing confounding in observational estimates of timing and outcome. [15]" ], "bullets": [ "Train teams to recognize hemorrhagic shock, perform hemorrhage-control adjuncts, administer blood products, and identify transfusion reactions. [13]", "Use case review to identify avoidable delays in recognition, protocol activation, product delivery, transfer, and source-control access. [13][15]" ], "subsections": [], "table": { "caption": "", "columns": [], "rows": [] } } ], "faq": [ { "question": "When should a major hemorrhage protocol be activated?", "answer": "Activate early when active bleeding with hemorrhagic shock is suspected. The supplied trauma evidence supports rapid standardized blood-component delivery and cites ACS TQIP guidance for initial components within 10 minutes of activation. [15]" }, { "question": "Which bedside findings are useful for recognizing hemorrhagic shock?", "answer": "Clinical assessment remains central. Serial vital signs, shock index, end-tidal carbon dioxide, and point-of-care lactate may support recognition; none should delay hemorrhage control when suspicion is high. [13]" }, { "question": "What external hemorrhage-control adjuncts should be used?", "answer": "Use pressure dressings and hemostatic wound packing for severe wounds, tourniquets for significant extremity bleeding, pelvic binders for suspected pelvic fractures, and wound packing or junctional tourniquets for junctional hemorrhage. [13]" }, { "question": "Is vasopressin standard therapy for traumatic hemorrhagic shock?", "answer": "No routine role can be established from the supplied evidence. A trial summary reports lower blood-product requirements with low-dose arginine vasopressin, but provides no dose, mortality result, or guideline recommendation. [16]" } ], "references": [ { "number": 1, "title": "prescribing information - accessdata.fda.gov", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/020702Orig1s079correctedlbl.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov" }, { "number": 2, "title": "This label may not be the latest approved by FDA. For current ...", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/021611s013s015lbl.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov" }, { "number": 3, "title": "[PDF] 3953322 1 This label may not be the latest approved by FDA. For ...", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/020938s026lbl.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov" }, { "number": 4, "title": "highlights of prescribing information", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=58d78805-3e8c-4859-b2e0-e3089f925280&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov" }, { "number": 5, "title": "2023 First Generic Drug Approvals | FDA", "detail": "www.fda.gov", "url": "https://www.fda.gov/drugs/drug-and-biologic-approval-and-ind-activity-reports/2023-first-generic-drug-approvals", "authors": "www.fda.gov", "host": "www.fda.gov" }, { "number": 6, "title": "https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/ ...", "detail": "nctr-crs.fda.gov", "url": "https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/bfdfe235-d717-4855-a3c8-a13d26dadede/spl-doc", "authors": "nctr-crs.fda.gov", "host": "nctr-crs.fda.gov" }, { "number": 7, "title": "1 This label may not be the latest approved by FDA. For ...", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/214783s005lbl.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov" }, { "number": 8, "title": "These highlights do not include all the information needed to use DEFERASIROX TABLETS FOR ORAL SUSPENSION safely and effectively. See full prescribing information for DEFERASIROX TABLETS FOR ORAL SUSPENSION.\n \n \nDEFERASIROX tablets for oral suspension\n \nInitial U.S. Approval: 2005", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=dc690f20-533e-490e-b13d-143382e02351&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov" }, { "number": 9, "title": "2025 First Generic Drug Approvals", "detail": "www.fda.gov", "url": "https://www.fda.gov/drugs/drug-and-biologic-approval-and-ind-activity-reports/2025-first-generic-drug-approvals", "authors": "www.fda.gov", "host": "www.fda.gov" }, { "number": 10, "title": "DailyMed - EFFEXOR XR- venlafaxine hydrochloride capsule, extended release", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c848a5d8-ba94-4c84-80e3-0bf35fb8e32e", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov" }, { "number": 11, "title": "Delayed Fluid Resuscitation of Head Injury and ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamasurgery/fullarticle/211566", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 12, "title": "Identification of major hemorrhage in trauma patients in the prehospital setting: diagnostic accuracy and impact on outcome | Trauma Surgery & Acute Care Open", "detail": "tsaco.bmj.com", "url": "https://tsaco.bmj.com/content/9/1/e001214", "authors": "tsaco.bmj.com", "host": "tsaco.bmj.com" }, { "number": 13, "title": "Prehospital blood transfusion coalition clinical practice guideline for civilian emergency medical services | Trauma Surgery & Acute Care Open", "detail": "tsaco.bmj.com", "url": "https://tsaco.bmj.com/content/10/3/e001931", "authors": "tsaco.bmj.com", "host": "tsaco.bmj.com" }, { "number": 14, "title": "Prehospital blood transfusion coalition clinical practice ...", "detail": "tsaco.bmj.com", "url": "https://tsaco.bmj.com/content/tsaco/10/3/e001931.full.pdf", "authors": "tsaco.bmj.com", "host": "tsaco.bmj.com" }, { "number": 15, "title": "Timing and volume of transfusion for adult major trauma patients with hemorrhagic shock: a registry-based cohort study | Trauma Surgery & Acute Care Open", "detail": "tsaco.bmj.com", "url": "https://tsaco.bmj.com/content/9/1/e001248", "authors": "tsaco.bmj.com", "host": "tsaco.bmj.com" }, { "number": 16, "title": "Effect of Low-Dose Supplementation of Arginine ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamasurgery/fullarticle/2749069", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 17, "title": "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 18, "title": "Digital twin mathematical models suggest individualized hemorrhagic shock resuscitation strategies", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s43856-024-00535-6", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 19, "title": "Articles on hemorrhagic shock published between 2000 ...", "detail": "www.cell.com", "url": "https://www.cell.com/heliyon/fulltext/S2405-8440(23)06048-6", "authors": "www.cell.com", "host": "www.cell.com" }, { "number": 20, "title": "Part 1: Executive Summary: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care | Circulation", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/CIR.0000000000001372", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 21, "title": "2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/ ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/CIR.0000000000001415", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 22, "title": "Current Concepts on the Management of Shock | Circulation", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/01.CIR.16.6.1097", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 23, "title": "Hemodynamic Management in Trauma and Hemorrhagic ...", "detail": "www.nature.com", "url": "https://www.nature.com/nature-index/topics/l4/hemodynamic-management-in-trauma-and-hemorrhagic-shock", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 24, "title": "Resuscitation from hemorrhagic shock after traumatic brain ...", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-021-81717-3", "authors": "www.nature.com", "host": "www.nature.com" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "prescribing information - accessdata.fda.gov", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/020702Orig1s079correctedlbl.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov", "snippet": "(2.3). • Pediatric Patients Aged 10 Years of Age and Older with HoFH: Recommended starting dosage is 10 to 20 mg once daily; dosage range is 10 to 80 mg once daily (2.4). • See full prescribing information for LIPITOR dosage modifications due to drug interactions (2.5). ---------------------DOSAGE F", "score": 0.6161283 }, { "number": 2, "title": "This label may not be the latest approved by FDA. For current ...", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/021611s013s015lbl.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov", "snippet": "with moderate or severe hepatic impairment. Use OPANA with caution in patients with mild hepatic impairment, starting with the lowest dose (e.g., 5 mg) and titrating slowly while carefully monitoring for signs of respiratory and central nervous system depression [see Warnings and Precautions (5.3) a", "score": 0.4527543 }, { "number": 3, "title": "[PDF] 3953322 1 This label may not be the latest approved by FDA. For ...", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/020938s026lbl.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov", "snippet": "serious cardiovascular, gastrointestinal, and/or renal adverse reactions. If the anticipated benefit for the elderly patient outweighs these potential risks, start dosing at the low end of the dosing range, and monitor patients for adverse effects [see Warnings and Precautions (5.1, 5.2, 5.3, 5.6, 5", "score": 0.3916624 }, { "number": 4, "title": "highlights of prescribing information", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=58d78805-3e8c-4859-b2e0-e3089f925280&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov", "snippet": "As hypotension associated with nitroglycerin overdose is the result of venodilatation and arterial hypovolemia, prudent therapy in this situation should be directed toward increase in central fluid volume. No specific antagonist to the vasodilator effects of nitroglycerin is known. Keep the patient ", "score": 0.29808816 }, { "number": 5, "title": "2023 First Generic Drug Approvals | FDA", "detail": "www.fda.gov", "url": "https://www.fda.gov/drugs/drug-and-biologic-approval-and-ind-activity-reports/2023-first-generic-drug-approvals", "authors": "www.fda.gov", "host": "www.fda.gov", "snippet": "| 89 | 208070 | Dabigatran Etexilate Capsules, 75 mg, 110 mg, 150 mg | Apotex, Inc. | Pradaxa (Dabigatran Etexilate) Capsules | 12/15/2023 | To reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation; for the treatment and prophylaxis of deep venous thrombo", "score": 0.27296153 }, { "number": 6, "title": "https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/ ...", "detail": "nctr-crs.fda.gov", "url": "https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/bfdfe235-d717-4855-a3c8-a13d26dadede/spl-doc", "authors": "nctr-crs.fda.gov", "host": "nctr-crs.fda.gov", "snippet": "2.7 Dosage Modifications in Geriatric Patients who are Debilitated and not Opioid-Tolerant For geriatric patients who are debilitated and not opioid-tolerant, start dosing patients at one-third to one-half the recommended starting dosage and titrate the dosage cautiously. Regularly evaluate for sig", "score": 0.25860015 }, { "number": 7, "title": "1 This label may not be the latest approved by FDA. For ...", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/214783s005lbl.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov", "snippet": "decrease the substrates dosage(s) in accordance with the respective Prescribing Information. (7.2) ----------------------USE IN SPECIFIC POPULATIONS-----------------------  Lactation: Advise not to breastfeed. (8.2)  Moderate or Severe Hepatic Impairment: Avoid use of REZUROCK in patients with mod", "score": 0.25760442 }, { "number": 8, "title": "These highlights do not include all the information needed to use DEFERASIROX TABLETS FOR ORAL SUSPENSION safely and effectively. See full prescribing information for DEFERASIROX TABLETS FOR ORAL SUSPENSION.\n \n \nDEFERASIROX tablets for oral suspension\n \nInitial U.S. Approval: 2005", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=dc690f20-533e-490e-b13d-143382e02351&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov", "snippet": "Patients with Baseline Hepatic Impairment\n\nMild (Child-Pugh A) Hepatic Impairment: No dose adjustment is necessary.\n\nModerate (Child-Pugh B) Hepatic Impairment: Reduce the starting dose by 50%.\n\nSevere (Child-Pugh C) Hepatic Impairment: Avoid deferasirox tablets for oral suspension\nsee Warnings and ", "score": 0.24296416 }, { "number": 9, "title": "2025 First Generic Drug Approvals", "detail": "www.fda.gov", "url": "https://www.fda.gov/drugs/drug-and-biologic-approval-and-ind-activity-reports/2025-first-generic-drug-approvals", "authors": "www.fda.gov", "host": "www.fda.gov", "snippet": "| 5 | 218211 | Ephedrine Sulfate Injection | Gland Pharma Limited | Emerphed Injection | 1/16/2025 | For the treatment of clinically important hypotension occurring in the setting of anesthesia. |\n| 4 | 218871 | Mesna Tablet | Novast Laboratories Limited | Mesnex Tablet | 1/13/2025 | For prophylacti", "score": 0.20112231 }, { "number": 10, "title": "DailyMed - EFFEXOR XR- venlafaxine hydrochloride capsule, extended release", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c848a5d8-ba94-4c84-80e3-0bf35fb8e32e", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov", "snippet": "The pharmacokinetics of venlafaxine and ODV are not substantially altered in the elderly see [Clinical Pharmacology (12.3)] (see Figure 1). No dose adjustment is recommended for the elderly on the basis of age alone, although other clinical circumstances, some of which may be more common in the elde", "score": 0.17762567 }, { "number": 11, "title": "Delayed Fluid Resuscitation of Head Injury and ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamasurgery/fullarticle/211566", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by PR Bourguignon · 1998 · Cited by 60 — Early fluid resuscitation with Ringer lactate solution following head injury and uncontrolled hemorrhagic shock worsens cerebral hemodynamics.", "score": 0.07185793 }, { "number": 12, "title": "Identification of major hemorrhage in trauma patients in the prehospital setting: diagnostic accuracy and impact on outcome | Trauma Surgery & Acute Care Open", "detail": "tsaco.bmj.com", "url": "https://tsaco.bmj.com/content/9/1/e001214", "authors": "tsaco.bmj.com", "host": "tsaco.bmj.com", "snippet": "after injury.25 26 However, predicting 10 units of packed red blood cells given within 24 hours is problematic: these cut-offs are arbitrary, there may be treatment bias (units transfused and units needed may differ), as well as survivor bias.24 27 28 Survivor bias can be partially mitigated by usin", "score": 0.32386157 }, { "number": 13, "title": "Prehospital blood transfusion coalition clinical practice guideline for civilian emergency medical services | Trauma Surgery & Acute Care Open", "detail": "tsaco.bmj.com", "url": "https://tsaco.bmj.com/content/10/3/e001931", "authors": "tsaco.bmj.com", "host": "tsaco.bmj.com", "snippet": "Rapid recognition of life-threatening hemorrhagic shock1:\n\nClinical assessment remains the cornerstone for recognition, including physiological parameters such as vital signs, shock index, end-tidal carbon dioxide (ETCO₂), and others.\n\nConsider point-of-care testing devices if available, such as lac", "score": 0.45057756 }, { "number": 14, "title": "Prehospital blood transfusion coalition clinical practice ...", "detail": "tsaco.bmj.com", "url": "https://tsaco.bmj.com/content/tsaco/10/3/e001931.full.pdf", "authors": "tsaco.bmj.com", "host": "tsaco.bmj.com", "snippet": "by MJ Levy · 2025 · Cited by 21 — This guideline supports early resus- citation with blood products for patients experi- encing hemorrhagic shock, regardless of etiology, with the objective of", "score": 0.44521654 }, { "number": 15, "title": "Timing and volume of transfusion for adult major trauma patients with hemorrhagic shock: a registry-based cohort study | Trauma Surgery & Acute Care Open", "detail": "tsaco.bmj.com", "url": "https://tsaco.bmj.com/content/9/1/e001248", "authors": "tsaco.bmj.com", "host": "tsaco.bmj.com", "snippet": "In conjunction with other measures of hemorrhage control, the American College of Surgeon Trauma Quality Improvement Program guidelines advise a maximum interval of 10 minutes between activation of an MHP to delivery of an initial set of blood components. Delays to blood components have been associa", "score": 0.26668465 }, { "number": 16, "title": "Effect of Low-Dose Supplementation of Arginine ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamasurgery/fullarticle/2749069", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by CA Sims · 2019 · Cited by 159 — Conclusions and Relevance Low-dose AVP during the resuscitation of trauma patients in hemorrhagic shock decreases blood product requirements.", "score": 0.06650261 }, { "number": 17, "title": "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "### Intended Use\n\nClinical practice guidelines provide recommendations applicable to patients with or at risk of developing cardiovascular disease (CVD). The focus is on medical practice in the United States, but these guidelines are relevant to patients throughout the world. Although guidelines may", "score": 0.27122802 }, { "number": 18, "title": "Digital twin mathematical models suggest individualized hemorrhagic shock resuscitation strategies", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s43856-024-00535-6", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Trauma is the leading cause of death and disability for individuals under the age of 55 years in the United States34.\"). Hemorrhage represents the leading cause of potentially preventable death in both civilian and military trauma patients in both the prehospital and in-hospital environments35. [...", "score": 0.26874477 }, { "number": 19, "title": "Articles on hemorrhagic shock published between 2000 ...", "detail": "www.cell.com", "url": "https://www.cell.com/heliyon/fulltext/S2405-8440(23)06048-6", "authors": "www.cell.com", "host": "www.cell.com", "snippet": "by H Ye · 2023 · Cited by 15 — In summary, the publication volume on hemorrhagic shock is expected to continue increasing in the future. The United States remains a core country in this field", "score": 0.21715525 }, { "number": 20, "title": "Part 1: Executive Summary: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care | Circulation", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/CIR.0000000000001372", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "Crossref\n\nPubMed\n\nGoogle Scholar\n\n184.\n\nBhate TD, McDonald B, Sekhon MS, Griesdale DE. Association between blood pressure and outcomes in patients after cardiac arrest: A systematic review. _Resuscitation_. 2015;97:1–6. doi: 10.1016/j.resuscitation.2015.08.023\n\nCrossref\n\nPubMed\n\nGoogle Scholar\n\n185.", "score": 0.15816164 }, { "number": 21, "title": "2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/ ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/CIR.0000000000001415", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "The focus of this clinical practice guideline is the evaluation and management of acute pulmonary embolism (PE) in the adult patient (≥18 years", "score": 0.14454715 }, { "number": 22, "title": "Current Concepts on the Management of Shock | Circulation", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/01.CIR.16.6.1097", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "In the handling of a patient with shock it is essential to identify the underlying cause in order to plan rational treatment. On the basis of information", "score": 0.12926002 }, { "number": 23, "title": "Hemodynamic Management in Trauma and Hemorrhagic ...", "detail": "www.nature.com", "url": "https://www.nature.com/nature-index/topics/l4/hemodynamic-management-in-trauma-and-hemorrhagic-shock", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Effective management of bleeding trauma and haemorrhagic shock centres on the rapid restoration and optimisation of circulating volume, vascular tone and", "score": 0.12561163 }, { "number": 24, "title": "Resuscitation from hemorrhagic shock after traumatic brain ...", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-021-81717-3", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "by CR Muller · 2021 · Cited by 45 — In HS resuscitation, the goal is to restore lost blood volume, while in the treatment of TBI the priority is focused on maintenance of adequate", "score": 0.11159915 } ], "publishedAt": "2026-08-21T00:27:50.990603+00:00", "updatedAt": "2026-08-21T00:27:50.990603+00:00", "readingMinutes": 5, "slug": "hemorrhagic-shock" }