The concept of permissive hypotension is a controversial topic in trauma care. While driving blood pressure to "normal" levels with large volume crystalloid infusions is not appropriate, definitive data on the target blood pressure for hypotensive resuscitation are lacking. Indeed, the concept of systolic blood pressure as a marker for resuscitation is arguable. In this case presentation, a panel of experts in trauma resuscitation discusses the merits and limitations of hypotensive resuscitation in the context of a patient who has sustained multiple injuries, including a head injury. The controversies highlighted herein call attention to the role of the intensivist in managing a continuing resuscitation while coordinating the care of other physicians whose therapies can run at cross-purposes to one another. The challenges of the practice of critical care in the 21st century are no more apparent than in the care of a complex trauma patient. © 2014 Elsevier Inc.