Current concepts in hemorrhagic shock

Treatment of hemorrhagic shock continues to evolve. Surgically, the concept of "damage control" has become the standard, with shorter operations focused on the control of life-threatening injuries. For the anesthesiologist, practice has changed, with a better understanding of the pathophysiology of shock, new techniques such as deliberate hypotension and perfusion-focused therapy, improved management of transfusion, and the advent of systemic hemostatic drug therapy. In this article, the author reviews each of these topics, and presents an integrated recommendation for early and late management of the patient in hemorrhagic shock.