<unk>  protocol <unk> P) has no universal definition but is generally considered as:
Transfusion of >10 units of packed red blood cells within a 24-hour period OR
Transfusion of >4 units of packed red blood cells within 1 hour, with anticipation of requiring more transfusion within the next 24 hours
In addition to controlling hemorrhage the greatest concern during<unk> P is the lethal triad:
Hypothermia
Coagulopathy
Acidosis
Trauma Associated Coagulopathy
Platelet defects (worse with TBI), endothelial injury, and loss of coagulation factors and platelets through hemorrhage consumption of platelets and coagulation factors
During<unk> P, focus is on "balanced resuscitation" with clotting factors (FFP) and platelets”
The PROPPR trial examined a 1:1:1 (FFP:Plt:pRBC) vs 1:1:2 protocol.  There was no difference in mortality at 1 or 30 days; however, the 1:1:1 group experienced less death due to exsanguination in the first day.
The goal of<unk> P is to resuscitate and temporize management until definitive operative repair can be accomplished.<unk> P should follow should follow local institutional protocols
Transfusion of >10 units of packed red blood cells within a 24-hour period OR
Transfusion of >4 units of packed red blood cells within 1 hour, with anticipation of requiring more transfusion within the next 24 hours
Platelet defects (worse with TBI), endothelial injury, and loss of coagulation factors and platelets through hemorrhage consumption of platelets and coagulation factors
Massive transfusion
Exchange transfusion
Transfusion-associated circulatory overload
Platelet transfusion
Blood products
Extracorporeal membrane oxygenation
Fresh frozen plasma
Cryoprecipitate transfusion