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To the Editor:—
I had enjoyed the generally excellent articles on CLINICAL MANAGEMENT, until it was suggested (201:123, 1967) that prompt and rational management of unexpected bleeding in surgical patients should include "immediate administration of fresh blood,... simultaneous administration of fibrinogen,... and administration of 500 mg of hydrocortisone intravenously." Later it stated that in the presence of undiagnosed, uncontrollable bleeding at the operating table, the following succession of therapeutic agents should be tried: "fresh blood, factor VIII-rich fibrinogen, cryoprecipitated factor VIII, protamine sulfate, hydrocortisone or corticotropin, and phytonadione."I was amazed at the almost complete lack of suggestion that findings of normal clotting studies might indicate lacerated blood vessels as the cause of "uncontrollable hemorrhage."Our most recent case involved a man who had the aortic valve replaced. Postoperatively, blood continued to drain from a chest tube at a rate of 1.5 liters/hr. The surgeons were
Morse EE, Wilson WB. Control of Hemorrhage. JAMA. 1967;202(2):152. doi:10.1001/jama.1967.03130150120031