PDF(Pubmed)
Abstract：
Traumatic hemorrhagic shock is a common yet life-threatening occurrence across the United States and is typically managed with blood transfusions as the standard of care. However, providers caring for a Jehovah\'s Witness patient who refuses transfusions due to religious reasons face unique ethical challenges in upholding evidence-based shock resuscitation protocols while respecting the patient\'s autonomy and faith-based stance that strictly prohibits blood products. We present a complex clinical case of a 46-year-old Jehovah\'s Witness who developed severe hemorrhagic shock, partial amputation, and critical anemia after a traumatic 40-mile-per-hour motorcycle collision resulting in comminuted fractures and arterial disruption. Despite receiving emergent blood transfusions initially, further transfusions were declined once his identity as a practicing Jehovah\'s Witness was disclosed. His hemoglobin plunged to dangerously low levels of 4.6 g/dL before stabilizing to 5.3 g/dL with pharmaceutical alternatives including intravenous iron, high-dose erythropoietin, and phlebotomy minimization. Respecting patient convictions while delivering effective evidence-based shock management created significant ethical conflicts given the proven efficacy of blood transfusions. However, this complex case demonstrates that through meticulous medical and surgical care coordinated by a multi-disciplinary team applying customized non-transfusion techniques, traumatic hemorrhagic shock and life-threatening anemia can still achieve favorable outcomes without relying on transfusions when respecting faith-based refusal of blood products.
摘要：
创伤性出血性休克是美国各地常见但危及生命的事件，通常以输血作为护理标准进行管理。然而,护理耶和华见证人患者的提供者因宗教原因拒绝输血，在坚持基于证据的休克复苏协议，同时尊重患者的自主权和严格禁止血液制品的基于信仰的立场方面面临着独特的道德挑战。我们介绍了一个复杂的临床病例，一个46岁的耶和华见证人出现严重的失血性休克，部分截肢,以及每小时40英里的摩托车碰撞导致粉碎性骨折和动脉破裂后的严重贫血。尽管最初接受紧急输血，一旦他作为实践耶和华见证人的身份被披露，进一步的输血被拒绝。他的血红蛋白骤降至危险的低水平4.6g/dL，然后用包括静脉注射铁在内的药物替代品稳定至5.3g/dL，大剂量促红细胞生成素,和静脉切开术最小化。考虑到输血的有效性，在提供有效的循证休克管理的同时尊重患者的信念会产生重大的道德冲突。然而,这个复杂的案例表明，通过由多学科团队应用定制的非输血技术协调的细致医疗和外科护理，创伤失血性休克和危及生命的贫血在尊重基于信仰的拒绝血液制品时,仍然可以在不依赖输血的情况下取得有利的结果.
