Use of Nitroglycerine to Improve Signs of Poor Peripheral Perfusion in Patients With Traumatic Hemorrhagic Shock

Inclusion Criteria: * Age: 20-60 years old. With the patient fully conscious or slightly drowsy. * Blood pressure: Systolic blood pressure below 90mmhg ,mean blood pressure below70mmhg or decrease of systolic blood pressure 40mmhg below normal value. * Metabolic acidosis: PH less than 7.35 due to hypoperfusion. * Capillary refill time \> 4 seconds. * Normal body core temperature. Exclusion Criteria: * Age: below 20 and above 60 years old. * Head trauma with Glasco coma score below 14 due to increased intracranial pressure (stroke, subarachnoid hemorrhage or brain trauma injury). * Severe hypotension not responding to fluid therapy. * Patient with bilateral ischemic arm injury. * Patient with hepatic cell failure * Patients admitted to the emergency trauma department after 6 hours of the trauma event. * Preexisting conditions as severe cardiovascular disease, uncontrolled hemorrhage, failure of central venous catheterization, dialytic procedure anticipated during the study period.