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Do you know an algorithm that addresses exsanguination in a patient that refuses blood?

A suggested treatment sequence is:

1. Identify the bleeding source
2. Stop the bleeding first
3. Once the bleeding has stopped, resuscitate aggressively.
   1. correction of coagulopathy
   2. Hi viscosity fluids if the hemoglobin is below 4.0
   3. Aggressive oxygenation (High FIO2)
   4. Pressors if needed to maintain perfusion (mean BP) > 55-60 mmHg.
4. "Damage control" surgery if needed
5. High dose EPO to restore Hb

Hypothermia is another option.

Aryeh Shander, MD, FCCM, FCCP