Which of the following is NOT a recommended action in field management of hemorrhagic shock?

• A. Permissive hypotension with judicious IV/IO fluids and rapid hemorrhage control
• B. Large-volume crystalloid resuscitation to normalize blood pressure before hemorrhage control
• C. Use IO access if IV fails
• D. Prioritize hemorrhage control

Answer: (B)

In field management of hemorrhagic shock, the priority is to stop the bleeding quickly while preserving perfusion, not to raise blood pressure to normal levels before the bleed is controlled. Large-volume crystalloid resuscitation aimed at normalizing blood pressure before hemorrhage control is not recommended because it can worsen bleeding: higher pressure can dislodge or disrupt forming clots, dilute clotting factors and platelets, and contribute to a worsening coagulopathy. This approach also wastes precious time that should be spent applying hemorrhage-control measures and transporting to definitive care.

The preferred strategy is permissive hypotension with judicious IV or IO fluids to support essential perfusion, paired with rapid hemorrhage control (bleeding control measures applied as quickly as possible) and expedient transport. If IV access is difficult, establishing IO access is appropriate so fluids and medications can still be given without delaying care.