Annex D Prolonged Casualty Care (PCC) Practice Test

In suspected hemorrhagic shock, the priority is to keep the patient perfused while not worsening the bleeding or displacing forming clots. This means resuscitation should be cautious and targeted rather than aggressive. A permissive hypotension approach aims to maintain enough blood pressure to sustain organ perfusion but not so high that it forces more bleeding or disrupts clots. If available, early use of blood products in balanced ratios (red cells with plasma and platelets) helps restore oxygen delivery and correct coagulopathy without the dilutional effects of large volumes of crystalloids. Crystalloid boluses in large amounts can dilute clotting factors, dilute platelets, worsen coagulopathy, and potentially increase bleeding. Waiting for a pulse before starting fluids ignores the need to support perfusion early, and relying on fluids alone or on colloids only does not address both oxygen delivery and coagulation. This combination—cautious fluid management to avoid displacing clots, permissive hypotension, and early blood products when available—best supports survival in hemorrhagic shock.