The combat hospital ICU

You have just finished your morning team ICU rounds on a mix of nine critically US and host-nation trauma patients. A tenth US casualty with multiple gunshot wounds to the chest and abdomen rolls in after a damage control laparotomy. He had become pulseless in the ED trauma bay during his initial evaluation, so he underwent an emergency thoracotomy and aortic cross clamp and was immediately taken to the OR while undergoing multiple blood transfusions. In the OR, he received over 40 units of products (PRBCs, FFP, PLTs, Cryo, whole blood) as well as a dose of TXA. The liver was packed and the abdomen left open with wound VAC placement. The patient is on high-dose norepinephrine and epinephrine and acidotic. Post-op ROTEM looks like a champagne flute.