Anesthesia Approach to Managing Severe Hemorrhagic Shock and Anemia With Non-transfusion Alternatives in a Practicing Jehovah's Witness: A Case Report.

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.

Interaction of Pristine Hydrocalumite-Like Layered Double Hydroxides with Carbon Dioxide.

The layered double hydroxides (LDHs) of Ca2+ and trivalent cations, Al3+ and Fe3+, are single-source precursors to generate supported CaO, which picks up CO2 from the gas phase in the temperature range 350-550 °C. The supports are ternary oxides, mayenite, and Ca2Fe2O5. The uptake capacity of the Fe3+-containing LDH at 1.9 mmol g-1 is two times the capacity of the Al3+-containing LDH. The product of CO2 uptake is calcite CaCO3. It is observed that the intercalated chloride ions reduce the thermal penalty by inducing the early decomposition of CaCO3. In the case of the chloride-intercalated LDHs of Ca2+ and Fe3+, the CaCO3 formed is completely decomposed at 900 °C. This is in contrast with the CaCO3 formed from bare CaO, which shows no sign of decomposition at 900 °C under similar conditions. This work shows that the hydrocalumite-like LDHs are candidate materials for CO2 mineralization.