Fig 1 describes damage control resuscitation.

Only the minority of patients require this approach. A decision needs to be made whether the patient needs to go to theatre immediately, whether investigations such as whole body CT or FAST scan can be carried out first, or whether their injuries can be managed without surgery.

Hypotensive resuscitation is not without risk and patients should not be left in a shocked state for long periods. A hybrid resuscitation approach with restoration of normotension after 60 minutes may be a good compromise.

Resource-poor environments may have limited diagnostic tests and intensive care facilities, but can often be good at getting patients to theatre quickly!