For people younger than 35 years, injury is currently the leading cause of death. One third of these result from hemorrhagic shock. By 2020, deaths from injury will probably increase to 8.4 million. Acute blood loss following injury leads to a reduction in tissue perfusion and tissue oxygen delivery, that, if prolonged, causes lactic acidosis and organ failure.
Despite significant advances, questions regarding the ideal resuscitation agent and the timing and endpoints of resuscitation remain unanswered. Recently, the standart practice of rapidly infusing crystalloid during resuscitation of hypotensive trauma victims has been called into question. This review outlines the etiology, pathophysiologic mechanisms as well as the general principles of emergency department management of the patient in shock.