[abstract] BURNS, HYPERBARIC OXYGENATION, BLOOD TRANSFUSION AND RELIGION.

Abstract

Jehovah's Witnesses believe they have an obligation to God to safeguard their own and their children's health; they do not use illicit drugs, do not smoke, do not practice abortion, etc. and they seek medical care when needed. However, they will not consent to the transfusion of blood, since they follow God's direction in the Bible (Acts 15:28-29); their refusal to receive blood transfusion is not a reckless decision but a protected right to refuse that particular medical treatment. Case Report: A 48 y.o.b.f. was flown by helicopter to the University of Missouri Hospital after the brakes in her car failed and it crashed into a gasoline storage tank, which exploded. Upon admission to the Burn ICU she was alert, with 55% BSA full thickness burns to her face, trunk, arms and legs. The Director of the BICU consulted with the Hyperbaric Medicine Center, since survival without blood transfusion was practically impossible. A joint effort was undertaken, with debridement and grafts kept to a minimum and HBO treatments in a Sigma II dual place chamber using the 45' Wound Healing Table (3x30 min O2/2x10 min air). The HBO treatments varied from 1 to 3 per day, with limitations related to the logistics of transporting the patient to the chamber. The hemoglobin/hematocrit values declined steadily from an initial 13.8 gm/41.5% to 2.4 gm/7.4%, and she required mechanical ventilation. Her cardiac output was between 10 and 11 liters most of the time, explaining the availability of oxygen to the tissues. Treatment with Folic Acid and Erythropoietin (total of 226,000 units) resulted in just some reticulocytes; she had a total of 53 HBO treatments over a 44 day period. 61 episodes of bradycardia and 81 episodes of asystole (some while in the chamber) made this case one of the most difficult to manage. The patient died on the 46th day of her hospital stay with a hemoglobin of 1.8 gm/dl; the burns and grafts were practically healed.