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Is whole blood better than 1:1:1 component therapy in haemorrhagic shock? Contradictory data from existing data and pending trials make this one of trauma's most contested questions - and an interesting one to ponder for ATLS candidates.
When a patient arrives with both a head injury and uncontrolled bleeding, two of trauma care's most important rules come into direct conflict. One demands a low blood pressure; the other demands a high one. This tension sits at the heart of modern ATLS practice - and the stakes could not be higher.
REBOA is not dead, but its indications have narrowed dramatically. The days of enthusiastic deployment for any patient in hemorrhagic shock are over. What replaces it - faster surgery, whole blood, xABCDE protocols, prehospital blood products - represents a trauma resuscitation paradigm that is less about a single technological fix and more about getting the fundamentals right, faster. That, ultimately, is what ATLS has always been about.