Pathology of organ damage after hemorrhagic shock by resuscitation with hypertonic saline or lactated Ringer's solution was examined. Neutrophil function was suppressed or augmented depending on the timing of administration of hypertonic saline. Cytokines of IL-6, IL-10, MCP-1 and TNF-α were elevated at 2h after hemorrhagic shock and resuscitation. Hypertonic saline reduced inflammatory cytokine production. Lung damage was observed at 24h after hemorrhagic shock and resuscitation. Hypertonic saline significantly reduced lung damage compared to lactated Ringer's solution. Also, early administration of hypertonic saline reduced lung damage compared with late administration. Apoptosis in the small intestine was observed at 2h and intestinal damage was observed at 6h after hemorrhagic shock and resuscitation. Hypertonic saline significantly reduced apoptosis and intestinal damage compared to lactated Ringer's solution. Effect of hypertonic saline on acute kidney injury was not seen. Since small volume of hypertonic saline administration restores blood pressure of hemorrhagic shock patients, administration of hypertonic saline may be useful for prehospital cases.

　　Controlling the active bleeding in injured patients is vital. Hence, it is necessary for early recognition and respond to massive bleeding. Prediction of massive bleeding includes drop in blood pressure and pulse, shock index, TASH score, ABC score, TBSS score, lactate, FDP, fibrinogen, Focused Assessment with Sonography for Trauma (FAST), and Computed tomographic scanning (CT). Hemostasis monitoring by thromboelastography or thromboelastometry is also useful for evaluating clotting mechanism. Regarding pre-hospital infusion, transportation of patient takes precedence if it is less than 30 minutes after injury. However, at hospitalization, based on the disease condition of the injured person, comprehensive clinical evaluation is needed. Comprehensive clinical management in massive bleeding includes permissive hypotension, tranexamic acid administration, massive transfusion therapy, administration of fibrinogen, and may involve surgical procedure.