Table 2 Hemostatic/Hemodynamic resuscitation following major trauma

Tranexamic Acid

within 3 h of injury loading dose 1 g over 10 min, followed by 1 g over 8 h

Ionized Calcium Levels

maintain in normal ranges during MT

Plasma : RBC

at least 1:2 (preferably 1:1) maintain Hb levels: 7–9 g/dl maintain coagulation parameters (repeated monitoring of PT, aPTT, fibrinogen levels, platelets count, viscoelastic testing) in normal ranges during MT

Fibrinogen

3–4 g administer in case of thromboelastometric signs of a functional fibrinogen deficit or a plasma fibrinogen level of less than 1.5 to 2 g/l

Platelet Count

50 × 10⁹/l if ongoing bleeding and/or TBI: 100 × 10⁹/l initial dose 4–8 single platelet units or 1 aphaeresis pack

Blood Pressure

SBP: 80 to 90 mmHg until hemorrhage control (no TBI) if severe TBI (GCS ≤ 8) MAP ≥ 80 mmHg

consider rFVIIa if major bleeding and traumatic coagulopathy persist despite maximal attempts to stop bleeding

in case of pre-trauma therapeutic anticoagulation or antiplatelets drugs consider specific treatment (ex. desmopressin, PCC, etc)