In a young patient with penetrating torso trauma and ongoing haemorrhage awaiting operative control, damage control resuscitation employs permissive hypotension. What systolic blood pressure target is recommended until surgical control of bleeding, and what important exception modifies this strategy?

• A Systolic 100 to 110 mmHg; no exceptions exist
• B Normal age expected blood pressure; hypotension is never tolerated
• C Systolic 80 to 90 mmHg; patients with traumatic brain injury require avoidance of hypotension ✓
• D Mean arterial pressure above 100 mmHg; elderly patients alone are excluded

Explanation

Permissive hypotension targets a palpable radial pulse and systolic around 80 to 90 mmHg in penetrating torso trauma, reducing uncontrolled bleeding from disrupted vessels and limiting dilutional coagulopathy before haemorrhage is controlled. The key exception is traumatic brain injury, where even a single episode of hypotension doubles mortality by reducing cerebral perfusion pressure; these patients require maintenance of normal perfusion pressure, making option C the only complete answer.

Reference: ATLS Advanced Trauma Life Support Student Course Manual, 10th ed.

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