A victim of blunt abdominal trauma has splenic and liver lacerations as well as an unstable pelvic fracture. He is hypotensive and tachycardic with a hea rate of 150 despite receiving 2 L of crystalloid en route to the hospital. He was intubated prior to arrival due to declining mental status. He is taken emergently to the operating room for exploratory laparotomy and external fixation of his pelvic fracture. Which of the following is the best resuscitative strategy?

The patient is in class IV hemorrhagic shock, which represents a loss of more than 40% of circulating blood volume. He requires massive blood transfusion. The term massive blood transfusion is defined as a single transfusion greater than 10 units of packed red blood cells (PRBCs) transfused over a period of 24 hours. There is evidence to suggest that severely injured trauma patients arrive at the hospital coagulopathic. Fuhermore, when large amounts of banked blood are transfused, the recipient develops dilutional thrombocytopenia and deficiencies in factors V and VIII. Recent studies have suggested that early administration of freshfrozen plasma (FFP) and platelets decreases moality and that a 1:1 ratio of PRBC:FFP should be initiated upon recognition of the need for massive transfusion. Waiting to administer FFP and platelets until laboratory values confirm coagulopathy is no longer recommended. Moreover, excessive crystalloid infusion should be avoided. Albumin has no role in damage control resuscitation. Vitamin K will take days to replace the clotting factors. This patient needs to have his coagulopathy corrected immediately to prevent death from hemorrhagic shock.