To assess and treat The calcium level abnormalities in major trauma pre and post receiving blood transfusions .

Primary objective:

• to evaluate the level of ionized calcium in multiple trauma patients with massive hemorrhage

Secondary objective:

• to build a relation between the level of ionized calcium and the degree of hemorrhagic shock

Inclusion Criteria:

1. >18 years old - < 70 years
2. Major trauma patients.
3. Admission and Ionized calcium measurement before blood transfusions

Exclusion Criteria:

1. patients below 18 years or > 70 years of age.
2. Pregnant women
3. Arrested patients
4. Patients managed outside the hospital and had received blood transfusions

In this study all consecutive adult multiple trauma patients presenting to the emergency department with the inclusion criteria until the sample size is satisfied.