An introduction to the initial hospital management of acute trauma

System
Sign
Cardiovascular	Increased heart rate Increased capillary refill time Decreased blood pressure (late sign) Decreased pulse pressure Cool and Clammy skin
Respiratory	Increased respiratory rate
Neurological	Confusion/ Agitation Decreased conscious level
Other	Decreased urine output

Signs of hypovolaemia


Circulation and haemorrhage control treatment options include:

• 
  Warm fluids (crystalloid / colloid)
  
• 
  Warm blood and blood products (eg Fresh Frozen Plasma),
  
• 
  Arrest bleeding by direct local pressure
  
• 
  Arrest bleeding by splinting pelvis
  
• 
  Central line if inotropes / vasopressors are needed
  
• 
  Urinary catheter
  
• 
  Surgery (‘damage control’ or definitive)