For hemorrhagic shock with suspected pelvic fracture, what is the initial resuscitation approach?

• A. Crystalloids only
• B. Balanced crystalloids; activate massive transfusion protocol (RBC: plasma: platelets = 1:1:1) and consider tranexamic acid within 3 hours of injury
• C. Colloids only
• D. RBC transfusion only

Answer: (B)

In hemorrhagic shock from a pelvic fracture, the approach is damage-control resuscitation: restore perfusion while rapidly stopping bleeding and preventing coagulopathy. Start with balanced crystalloids to support circulation but avoid large volumes that can dilute clotting factors and worsen acidosis. At the same time, activate the massive transfusion protocol so blood products are given in a 1:1:1 ratio of red cells, plasma, and platelets to replace what's lost and to restore clotting factors. Within about 3 hours of injury, give tranexamic acid to reduce fibrinolysis and further limit bleeding. This combination targets both volume replacement and coagulation restoration, which is essential in pelvic-fracture–related bleeding. Using crystalloids alone would not address coagulopathy, and relying on any single component (colloids or RBCs only) would miss critical plasma and platelet support needed to form stable clots.