Physiology-Driven Decision-Making in Trauma-Induced Coagulopa-thy: Integrating Shock Index, FAST, and Hemostatic Resuscitation

Trauma-induced coagulopathy (TIC) is a major determinant of early mortality in severely injured patients and represents a complex, multifactorial physiological disorder that develops shortly after injury. It results from the interaction between tissue hypoperfusion, endothelial dysfunction, inflammatory activation, and dysregulation of coagulation and fibrinolysis pathways. Contemporary evidence demonstrates that tissue hypoperfusion may precede overt hypotension, requiring integrated diagnostic and therapeutic strategies. This narrative review discusses the role of the Shock Index, focused assessment with sonography for trauma (FAST/eFAST), and computed tomography in the early stratification of hemorrhagic shock, as well as their integration with damage control resuscitation principles, including early tranexamic acid administration. The coordinated application of these tools allows earlier surgical decision-making, reduces therapeutic delays, and improves clinical outcomes, particularly in emergency settings and public healthcare systems.