Hemorrhagic shock continues to be a major contributor to trauma-related fatalities globally, posing a significant and intricate pathophysiological challenge. The condition is marked by injury and blood loss, which activate molecular cascades that can quickly become harmful. The inflammatory response exhibits a biphasic pattern, beginning with a hyper-inflammatory phase that transitions into immunosuppression, posing significant obstacles to effective therapeutic interventions. This review article explores the intricate molecular mechanisms driving inflammation in hemorrhagic shock, emphasizing cellular signaling pathways, endothelial dysfunction, and immune activation. We discuss the role of molecular biomarkers in tracking disease progression and stratifying risk, with a focus on markers of endothelial dysfunction and inflammatory mediators as potential prognostic tools. Additionally, we assess therapeutic strategies, spanning traditional approaches like hemostatic resuscitation to advanced immunomodulatory treatments. Despite promising advancements in molecular monitoring and targeted therapies, challenges persist in bridging experimental findings with clinical applications. Future efforts must prioritize understanding the dynamic progression of inflammatory pathways and refining the timing of interventions to improve outcomes in hemorrhagic shock management.