Damage control resuscitation, characterized by hemostatic resuscitation with blood
products, rapid arrest of bleeding and when possible, permissive hypotension with restricted fluid load form a structured approach in managing a polytrauma
patient. When complicated with traumatic rhabdomyolysis however, permissive
hypotension strategy may cause more harm resulting in subsequent ischaemicreperfusion
injury and acute kidney injury. We present a case involving a 20-yearold
man who was rolled over by a lorry and sustained an open unstable pelvic
fracture with vascular injury and left lower limb ischaemia. Permissive hypotension
strategy was pursued for 4 hours prior to bleeding control in OT. This was
followed by protracted surgery of 6 hours. Coagulopathy, acute kidney injury and
rhabdomyolysis ensued in the post-operative period and patient succumbed to
his injury on Day 3 post-trauma. Challenges and pitfalls in managing a complex
polytrauma patient and recent evidences on damage control resuscitation is
discussed