How is hemorrhagic shock treated?
Compelling evidence exists in adult populations about massive transfusion protocols and balanced ratios of blood products in lieu of crystalloid resuscitation. Although little evidence exists in the pediatric literature, many trauma centers have adapted adult protocols to their pediatric patients. The tenets of these protocols involve minimizing crystalloid fluid and judicious transfusion of blood products in ratios that more closely mimic fresh whole blood. Undoubtedly some patients with mild blood loss can be managed with crystalloid, but patients with severe (class III and IV) hemorrhage will require blood replacement therapy.
Dehmer JJ, Adamson WT: Massive transfusion and blood product use in the pediatric trauma patient. Semin Pediatr Surg 2010;19(4):286-291.
Spinella PC, Holcomb JB: Resuscitation and transfusion principles for traumatic hemorrhagic shock. Blood Rev 2009;23(6):231-240.