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Exsanguination

Exsanguination is the extreme and rapid loss of blood from the circulatory system, defined as hemorrhage exceeding 40% of total blood volume, which triggers hypovolemic shock and often results in death without immediate intervention.^[1]^[2] This condition arises predominantly from traumatic injuries such as penetrating wounds, blunt force trauma, or major vascular disruptions, though it can also stem from intraoperative complications or gastrointestinal bleeding in non-trauma settings.^[3]^[4] Physiologically, it initiates a compensatory cascade involving tachycardia, vasoconstriction, and fluid shifts to maintain perfusion, but progression depletes oxygen delivery to tissues, leading to acidosis, coagulopathy, and multi-organ failure in advanced stages.^[5]^[3] Early symptoms manifest as anxiety, pallor, and oliguria, escalating to profound hypotension, confusion, and cardiac arrest as blood loss surpasses critical thresholds.^[3] In trauma contexts, exsanguination accounts for a substantial proportion of preventable prehospital deaths, underscoring its role as a primary target for interventions like tourniquets, hemostatic agents, and damage control resuscitation protocols that prioritize hemorrhage control over traditional airway management in extremis.^[6]^[7] Treatment emphasizes rapid volume replacement with blood products, surgical hemostasis, and permissive hypotension to avoid exacerbating bleeding, with survival rates remaining low—around 10% in cases advancing to cardiac arrest—highlighting the narrow therapeutic window.^[8]^[2]

Definition and Physiology

Mechanism of Blood Loss and Death

Exsanguination occurs when rapid or substantial blood loss reduces circulating volume below levels sufficient to maintain vital organ perfusion, primarily leading to death via hypovolemic shock.^[9] In adults, total blood volume averages 70 mL/kg body weight, equating to approximately 4.5-5.5 liters for a 70 kg individual; losses exceeding 40% (Class IV hemorrhage) typically prove fatal without immediate intervention, as cardiac output falls precipitously due to inadequate venous return and preload.^[3] This initiates a cascade where oxygen delivery to tissues drops, causing cellular hypoxia, anaerobic metabolism, and lactic acidosis, with arterial blood pressure plummeting as compensatory vasoconstriction fails. The pathophysiological sequence begins with baroreceptor-mediated sympathetic activation, increasing heart rate and contractility while redirecting blood to the heart and brain via peripheral vasoconstriction; however, in severe cases, these mechanisms exhaust within minutes, leading to profound hypotension and tachycardia exceeding 140 beats per minute. Tissue hypoperfusion then triggers endothelial damage, microvascular thrombosis, and inflammatory cytokine release, exacerbating ischemia; the brain, with high oxygen demand, suffers irreversible neuronal death after 4-6 minutes of profound hypoxia, while myocardial ischemia induces arrhythmias or arrest. Death ensues from cardiopulmonary collapse, often within 3-5 minutes of Class IV hemorrhage onset in trauma settings, though slower bleeds (e.g., 20-30% over hours) may allow partial compensation until cumulative hypovolemia overwhelms reserves. Factors influencing lethality include bleed rate—arterial lacerations causing >150 mL/min loss accelerate demise compared to venous oozing—and patient variables like age, comorbidities, and baseline fitness; for instance, hemorrhagic shock mortality rises above 50% when blood loss surpasses 2 liters without resuscitation, per military and civilian trauma data. Coagulopathy from dilution, hypothermia, and acidosis (the "lethal triad") further impairs hemostasis, perpetuating loss in a vicious cycle, as evidenced by studies showing factor depletion after 1.5 blood volume replacements. Empirical models, such as porcine hemorrhage simulations, confirm that survival hinges on restoring volume before mean arterial pressure falls below 50 mmHg, beyond which renal and hepatic failure compound fatality.

Pathophysiological Stages and Lethality Factors

Exsanguination induces hemorrhagic shock through progressive hypovolemia, impairing cardiac output and tissue perfusion. The condition is classified into four stages based on estimated blood volume loss in a typical 70-kg adult with a total blood volume of approximately 5 liters. In Class I hemorrhage, up to 15% volume loss (≤750 mL) occurs with minimal clinical signs, as baroreceptor-mediated sympathetic activation increases heart rate slightly (80-100 bpm) and vasoconstriction maintains blood pressure, while renal blood flow and urine output remain normal.^[3]^[10] Class II hemorrhage involves 15-30% loss (750-1,500 mL), triggering more pronounced compensatory responses: heart rate exceeds 100 bpm, respiratory rate rises above 20 breaths per minute, and pulse pressure narrows due to tachycardia and peripheral vasoconstriction, though systolic blood pressure stays near normal (≥100 mmHg); urine output falls to 20-30 mL/hour, and anxiety or restlessness may emerge from cerebral hypoperfusion.^[3] Class III, with 30-40% loss (1,500-2,000 mL), marks decompensation: hypotension develops (systolic <90 mmHg), heart rate surpasses 120 bpm, respiratory rate exceeds 30 breaths per minute, urine output drops below 20 mL/hour, and mental status deteriorates to confusion, reflecting inadequate oxygen delivery and early anaerobic metabolism with lactic acidosis.^[3] Class IV, exceeding 40% loss (>2,000 mL), constitutes profound shock with systolic pressure below 70 mmHg, negligible urine output, and obtundation or coma, leading to multi-organ dysfunction from cellular hypoxia and ischemia if untreated.^[3] These stages reflect a cascade where reduced venous return decreases stroke volume, prompting neuroendocrine responses (e.g., catecholamine release, renin-angiotensin activation) that initially compensate but fail as hypoperfusion causes microvascular dysfunction, endothelial damage, and inflammatory cytokine release.^[11] Lethality hinges on the rate and volume of hemorrhage, with rapid arterial bleeding (e.g., >150 mL/min) far more fatal than slow venous loss, as compensation overwhelms quickly and total exsanguination can occur within minutes.^[10] The "lethal triad" of acidosis (pH ≤7.2 from lactate accumulation), hypothermia (<34°C impairing enzyme function and coagulation), and coagulopathy (dilutional or trauma-induced, worsening bleeding via factor depletion and fibrinolysis) forms a vicious cycle amplifying mortality, observed in up to 70% of exsanguinating trauma cases.30082-0/fulltext)^[12] Additional factors include bleed site (non-compressible torso or junctional wounds increase risk over extremity injuries), patient comorbidities (e.g., elderly or atherosclerotic individuals tolerate less loss), baseline hemoglobin, and prehospital delays, with >4,000 mL blood replacement in surgery signaling high mortality (69% in one cohort).^[12]^[13] Without intervention, Class IV shock yields near-certain death from cardiac arrest due to profound hypovolemia and metabolic derangement.^[3]

Causes in Humans

Traumatic Exsanguination

Traumatic exsanguination refers to rapid and severe blood loss leading to death from injuries that damage major blood vessels or organs, typically occurring within minutes to hours if uncontrolled. It accounts for approximately 30-40% of all trauma-related mortality, with 33-56% of hemorrhagic deaths happening in the prehospital phase due to the inability to achieve hemostasis.^[14] In multicenter studies of trauma outcomes, exsanguination ranks as the second leading cause of death after traumatic brain injury, comprising about 23% of cases, often from truncal or extremity vascular disruption.^[15] Penetrating trauma, such as gunshot wounds or stabbings, frequently causes exsanguination by directly lacerating arteries like the femoral or axillary, leading to arterial hemorrhage rates exceeding 500 mL/min in proximal injuries. Blunt trauma, including motor vehicle collisions (accounting for 83.5% of blunt cases in some registries) and falls, contributes via shearing forces on vessels, such as aortic transection at the isthmus or cardiac rupture.^[16]^[17] Junctional zones (groin, axilla, neck) pose high risk due to limited compressibility, with peripheral injuries alone causing exsanguination in a subset of cases where tourniquets fail or are delayed.^[18] Mortality predictors include low systolic blood pressure (<90 mmHg), hypothermia (<35°C), intra-abdominal injury, and high injury severity scores, with early exsanguination deaths showing odds ratios up to 5.2 for combined factors in adult trauma cohorts.^[19] In military settings, exsanguination from extremity wounds is more lethal than in civilians due to higher kinetic energy transfers and evacuation delays, though civilian penetrating extremity fatalities remain low (under 1% of isolated cases) with prompt intervention.^[20] Advances in damage control resuscitation have reduced but not eliminated these rates, emphasizing immediate hemorrhage control over airway prioritization in exsanguinating patients to avoid worsening hypotension.^[7]

Medical and Iatrogenic Causes

Medical causes of exsanguination encompass spontaneous, non-traumatic hemorrhages from underlying pathologies that result in rapid and voluminous blood loss, often exceeding 40% of total blood volume and leading to hypovolemic shock. Ruptured abdominal aortic aneurysms represent a primary example, with overall mortality rates around 48.5% despite intervention, and prehospital or immediate death rates approaching 80% due to uncontrollable retroperitoneal or intraperitoneal bleeding. Similarly, massive upper gastrointestinal bleeding from sources such as peptic ulcers, esophageal varices, or arteriovenous malformations like Dieulafoy's lesion can cause exsanguination, with annual incidence rates of 80 to 150 cases per 100,000 population and mortality in severe cases ranging from 5% to 15%, particularly when hemodynamic instability develops early. Other contributors include ruptured visceral aneurysms or tumors eroding major vessels, which precipitate fatal hemorrhage through direct vascular disruption.^[21]^[22]^[23] Iatrogenic exsanguination arises from medical interventions or treatments that inadvertently provoke massive hemorrhage, often in vulnerable patients with comorbidities. In hemodialysis patients, accidental disconnection or puncture of arteriovenous fistulas has led to fatal exsanguination, with reported cases involving underlying conditions like hypertensive cardiovascular disease and diabetes mellitus as common precursors to end-stage renal disease. Surgical injuries to abdominal or pelvic veins during procedures such as hysterectomies or vascular repairs account for significant morbidity, with mortality risks elevated in cases of delayed recognition or inadequate hemostasis, though specific exsanguination rates vary by operative context. Additionally, complications from arterial catheterization, including femoral pseudoaneurysm formation and rupture, can result in rapid blood loss, particularly in non-sterile or infected settings where revascularization is contraindicated.^[24]^[25]^[26] These iatrogenic events underscore the causal role of procedural factors in amplifying hemorrhage risk, independent of patient baseline coagulopathy, with forensic analyses confirming direct vessel transection or erosion as the proximate mechanism in many fatalities. Preventive strategies, such as vigilant monitoring of vascular access sites and prompt imaging for suspected pseudoaneurysms, mitigate but do not eliminate these risks, as evidenced by persistent case reports in medical literature.^[27]^[28]

Postpartum and Obstetric Hemorrhage

Postpartum hemorrhage (PPH), defined as blood loss exceeding 500 mL following vaginal delivery or 1,000 mL after cesarean section, represents the primary mechanism of obstetric hemorrhage culminating in exsanguination, characterized by rapid, uncontrolled arterial and venous bleeding from the placental implantation site.^[29] Uterine atony accounts for 75-90% of primary PPH cases, where failure of the myometrium to contract post-delivery prevents vascular compression, allowing persistent hemorrhage that can progress to hypovolemic shock and death within minutes if unaddressed.^[30] Other contributors include genital tract trauma (e.g., lacerations or uterine rupture), retained placental tissue, and coagulopathies such as disseminated intravascular coagulation (DIC), often exacerbated by massive transfusion or underlying conditions like preeclampsia.^[31] ^[32] Obstetric hemorrhage extends to antepartum (e.g., placental abruption or previa) and intrapartum bleeding, but postpartum variants predominate in exsanguination risk due to the expanded uterine vascular bed—up to 10 times normal volume—and delayed recognition in resource-limited settings.^[33] Risk factors include prolonged labor, multiple gestation, fetal macrosomia (>4,000 g), operative vaginal delivery, multiparity, and prior PPH, with incidence rising globally amid increasing cesarean rates.^[34] In the U.S., PPH rates climbed from 2.7% in 1994 to 5.1% by 2017, correlating with higher severe morbidity.^[35] Globally, PPH causes approximately 70,000 maternal deaths annually, comprising 20-27% of all pregnancy-related fatalities, with disproportionate burden in low-resource areas where delays in uterotonic administration or surgical intervention amplify exsanguination lethality.^[36] ^[37] In developed regions, it accounts for 8-10% of maternal deaths, reflecting improved access to transfusions and hysterectomy, though coagulopathy from acute blood loss remains a terminal pathway, diluting clotting factors and perpetuating bleeding.^[38] ^[39] Pathophysiologically, compensatory tachycardia gives way to decompensation at 30-40% blood volume loss (1.5-2 L in adults), inducing organ failure; survival hinges on restoring volume and hemostasis before irreversible ischemia.^[29] Early markers like visual blood loss estimation aid prognosis, though inaccuracies contribute to underestimation and higher mortality.^[40]

Intentional Exsanguination in Animals

Industrial Slaughter Methods

Industrial slaughter methods for livestock primarily involve stunning to induce unconsciousness followed by exsanguination to cause death through rapid blood loss, aiming to ensure animal insensibility, carcass hygiene, and meat quality.^[41] Stunning precedes bleeding to prevent perception of pain during the cut, with methods selected based on species: mechanical captive bolt pistols for cattle and sheep deliver a penetrating or non-penetrating impact to the forehead, disrupting brain function; electrical stunning applies current via head electrodes for ruminants or water baths for poultry, inducing epileptiform activity; and controlled atmosphere stunning uses carbon dioxide gas for pigs to cause hypercapnia and loss of consciousness.^[42] The stun-to-stick interval is typically limited to 15 seconds or less to maintain effectiveness, as prolonged delays can allow recovery of sensibility.^[43] Exsanguination is achieved by severing major blood vessels, such as the carotid arteries and jugular veins, usually via a precise neck incision or thoracic stick, facilitating drainage into collection troughs or conveyors.^[44] This process targets removal of 45-50% of total blood volume, equivalent to about 3% of live weight, to minimize residual blood that could promote microbial growth, affect meat pH, and cause discoloration or oxidative instability.^[45] ^[46] Bleeding duration varies by species and system efficiency, with studies indicating 15 minutes optimizes blood loss without compromising beef quality attributes like color and chemical composition, though incomplete bleeding—often due to improper vessel severance or clotting—reduces yield and elevates quality defects.^[47] In high-throughput abattoirs, automated lines process hundreds of animals hourly, with bleed-out occurring on inverted shackles or rails to leverage gravity for efficient drainage.^[48] Effectiveness of these methods hinges on operator training and equipment calibration, as suboptimal stunning (e.g., missed bolt placement or insufficient current) can result in conscious animals during bleeding, though regulatory monitoring in jurisdictions like Canada mandates immediate re-stunning upon signs of sensibility.^[41] Blood collected serves industrial purposes, including rendering for feed or disposal, while poor exsanguination correlates with higher lipid oxidation and microbial loads during storage.^[49] Variations exist for poultry, where automated neck cutters follow electrical stunning, achieving similar blood removal rates but requiring precise shackling to avoid carotid misses.^[50] Overall, these protocols prioritize rapid, controlled death to support scalable meat production while addressing welfare through pre-bleed insensibility.^[51]

Religious Slaughter Practices

In Jewish shechita, a certified slaughterer (shochet) executes a single, uninterrupted transverse incision across the neck of a conscious animal using a razor-sharp, defect-free knife (chalaf), severing the carotid arteries, jugular veins, trachea, and esophagus to induce rapid exsanguination and death via hypovolemic shock.^[52] This method prohibits any form of pre-slaughter stunning, as it is deemed incompatible with kosher requirements for the animal to be healthy and fully sensible at the time of the cut.^[53] Proponents assert that a properly performed incision causes near-instantaneous cerebral ischemia due to massive blood outflow, minimizing suffering, though empirical observations indicate variability based on cut precision and animal species.^[54] Islamic dhabihah (halal slaughter) similarly entails a sharp knife incision severing the throat structures—including the carotid arteries, jugular veins, and windpipe—while the animal remains conscious and facing the qibla, accompanied by invocation of Allah's name, followed by complete exsanguination to purify the meat.^[55] Unlike shechita, some halal interpretations permit reversible pre-slaughter stunning (e.g., low-voltage electrical methods) provided it does not cause death or impede blood drainage, though strict adherents reject stunning entirely to ensure the animal's viability during the cut.^[56] Blood must be fully drained post-incision, as consumption of undrained meat is forbidden.^[57] Both practices prioritize exsanguination as the primary mechanism of death, distinguishing them from secular methods that mandate stunning for immediate insensibility.^[52] Veterinary assessments reveal that in unstunned slaughter, cattle may exhibit EEG indicators of consciousness for 5–20 seconds or longer after the cut if vascular severance is incomplete, potentially allowing nociception before full cerebral anoxia, whereas smaller animals like sheep lose sensibility more rapidly (often under 10 seconds).^[54] Comparative cortisol studies show elevated stress hormones in unstunned animals versus stunned counterparts, supporting claims of heightened welfare risks, though meat quality parameters remain comparable across methods when hygiene is maintained.^[53] Regulatory exemptions for religious slaughter persist in jurisdictions like the United States and European Union, balancing welfare concerns against faith-based rights, despite evidence favoring pre-stunning for consistent unconsciousness.^[58]

Evidence on Animal Welfare and Consciousness

Scientific studies assessing animal consciousness during exsanguination without prior stunning primarily rely on neurophysiological measures such as electroencephalography (EEG), behavioral indicators like reflexes and posture, and physiological markers including cortisol levels and heart rate. EEG recordings in cattle indicate an average time to loss of spontaneous brain activity of 75 ± 48 seconds post-neck incision, with a range of 19 to 113 seconds, suggesting potential for prolonged consciousness and associated suffering.^[59] In sheep, some evaluations report persistence of consciousness indicators, such as corneal and palpebral reflexes, beyond 90 seconds after the cut, supporting claims of extended sensibility.^[60] These findings contrast with claims of near-instantaneous unconsciousness from carotid severance, as variability in incision efficacy and individual animal factors can delay cerebral ischemia.^[61] Behavioral and reflex-based assessments further highlight welfare risks in unstunned slaughter. Loss of posture or rhythmic breathing serves as a proxy for unconsciousness, but studies observe increased prevalence of ocular reflexes and vocalizations post-incision in non-stunned ruminants, indicating ongoing sensory awareness.^[62] The European Food Safety Authority recommends monitoring these indicators immediately after neck cutting to verify insensibility, noting that failure to achieve rapid loss correlates with pain from the incision and hypovolemic shock.^[63] Restraint required for accurate neck cuts in conscious animals exacerbates stress, with elevated heart rates and cortisol surges observed during the process compared to pre-slaughter baselines.^[64] Stress hormone analyses provide mixed but predominantly concerning evidence for unstunned methods. Plasma cortisol levels in non-stunned cattle often rise significantly during exsanguination, reflecting acute distress from tissue damage and blood loss, unlike the blunted response following effective stunning.^[53] Reviews of halal and kosher practices note higher catecholamine and cortisol concentrations in unstunned animals relative to stunned counterparts, linking these to perceived pain and fear.^[65] While some studies report lower baseline cortisol in ritually selected animals due to handling protocols, the slaughter phase itself induces marked elevations, undermining assertions of superior welfare.^[66] Overall, empirical data from controlled trials favor pre-slaughter stunning for minimizing consciousness duration and distress, though debates persist over incision precision and species-specific tolerances.^[62]^[56]

Exsanguination as Suicide Method

Common Techniques and Prevalence

The most common technique for intentional exsanguination in suicide involves laceration of the radial or ulnar arteries at the wrist or forearm using sharp-edged instruments such as razors, knives, or broken glass, often requiring deep incisions to transect the vessel walls for sufficient blood loss.^[67]^[68] Less frequently, individuals target larger vessels like the femoral artery in the groin or thigh, or the carotid artery and jugular vein in the neck, which can lead to more rapid hemorrhage but demand greater precision and access, sometimes involving stabbing rather than slashing.^[69]^[70] These methods typically occur in private settings like bathrooms or bathtubs to facilitate blood collection and reduce mess, with preparatory behaviors including alcohol consumption to dull pain or impair clotting.^[67] Completed suicides by exsanguination via sharp force injuries represent 1.6% to 3% of all suicide deaths across studied populations, reflecting their relatively low lethality compared to methods like firearms or hanging, as superficial cuts often allow for intervention or natural hemostasis.^[71] In contrast, cutting accounts for up to 21.7% of nonfatal suicide attempts, highlighting a disparity where intent for exsanguination succeeds only when major vessels are severed without timely medical aid.^[72] Prevalence varies by demographics, with higher attempt rates among females and younger individuals, though male completions may involve more lethal sites like the neck or groin.^[68] Global estimates from WHO data indicate bladed weapon suicides contribute modestly to the over 700,000 annual suicide deaths, often underreported due to classification under broader "sharp force" categories.^[73]

Lethality, Pain, and Survival Rates

Exsanguination as a suicide method, typically involving incision of wrists or other accessible arteries, demonstrates low lethality relative to other approaches such as firearms or hanging. A meta-analysis of suicide methods reports a case fatality rate of approximately 4% for cutting, contrasting sharply with rates exceeding 80% for hanging or suffocation.^[74] This low lethality stems from anatomical challenges, including the depth of major vessels like the radial or ulnar arteries, which are often shielded by tendons and require precise, deep cuts rarely achieved in impulsive acts; superficial or hesitant incisions predominate, affecting over 70% of cases in examined cohorts.^[67] Survival rates exceed 95% in documented attempts, as evidenced by retrospective analyses where all patients presenting to emergency departments survived initial exsanguination efforts.^[67]^[75] Factors enhancing survival include rapid clotting mechanisms, vasoconstriction, and bystander or self-intervention via pressure application; only deep injuries transecting neurovascular structures (occurring in about 11-47% of severe cases) pose immediate life threats, yet even these frequently allow timely medical access.^[67]^[75] Attempts targeting larger vessels, such as femoral arteries, yield higher lethality but remain uncommon due to access difficulties and increased initial pain deterring completion.^[70] Pain in successful exsanguination unfolds in phases: acute sharpness from the initial incision, moderated by endorphin release and numbed by ensuing hypovolemic shock, which impairs nociception through reduced tissue perfusion and cerebral hypoxia.^[76] Unconsciousness typically precedes terminal blood loss, rendering prolonged suffering unlikely; physiological responses prioritize vital organ diversion over pain signaling, with reports from near-fatal cases describing weakness and disorientation over sustained agony.^[76] In failed attempts, pain arises more from surgical repair of tendon or nerve damage than the bleeding itself, with long-term sequelae like neuropathy in up to 24% of deep injuries.^[75] Overall, the method's perceived "gentleness" contributes to its selection in low-lethality intents, though empirical outcomes underscore frequent rescue and minimal fatal efficiency.^[77]

Prevention and Treatment Strategies

Advances in Trauma Resuscitation

Damage control resuscitation (DCR) represents a paradigm shift in managing exsanguinating hemorrhage, emphasizing early hemorrhage control, limited crystalloid use, permissive hypotension, and balanced transfusion of plasma, platelets, and red blood cells to mitigate coagulopathy, acidosis, and hypothermia—the "lethal triad."^[78] Originating from military experiences in Iraq and Afghanistan, DCR prioritizes restoring physiological homeostasis over aggressive volume replacement with crystalloids, which can exacerbate dilutional coagulopathy and increase bleeding.^[79] Guidelines from the Joint Trauma System, updated as of 2019, recommend initiating DCR in the prehospital or emergency phase for patients with severe traumatic hemorrhage, achieving improved survival rates in combat settings compared to traditional Advanced Trauma Life Support (ATLS) protocols that favored sequential crystalloid resuscitation.^[78] Permissive hypotension, a core DCR principle, involves maintaining systolic blood pressure at 80-90 mmHg (or mean arterial pressure of 50 mmHg) in actively bleeding patients until definitive hemostasis, avoiding over-resuscitation that could dislodge forming clots and worsen hemorrhage.^[80] This approach, supported by animal models and observational trauma studies, contrasts with historical targets of normal blood pressure via large-volume fluids, which correlate with higher mortality due to increased blood loss.^[81] A 2021 meta-analysis confirmed permissive hypotension's survival benefit in penetrating torso injuries without traumatic brain injury, though it requires caution in head-injured patients where cerebral perfusion must be preserved above 90 mmHg systolic.^[82] Tranexamic acid (TXA), an antifibrinolytic agent, inhibits fibrinolysis to stabilize clots in hyperfibrinolytic states common in trauma-induced coagulopathy. The CRASH-2 randomized controlled trial, involving 20,211 bleeding trauma patients, demonstrated that TXA administered within 3 hours of injury reduced all-cause mortality by 1.5% (14.5% vs. 16% in placebo) and bleeding death by 1.9%, with no increase in vascular occlusive events when given early.60835-5/fulltext) Subsequent prehospital trials, such as the 2023 PATCH-Trauma study, reinforced TXA's role in severe trauma, prompting inclusion in guidelines like those from the American College of Surgeons for patients with significant hemorrhage. Hemostatic resuscitation advances favor early use of blood products over crystalloids, with balanced ratios approximating whole blood composition—typically 1:1:1 for red blood cells, plasma, and platelets—to correct coagulopathy proactively.^[78] Low-titer group O whole blood (LTOWB) has reemerged as superior to component therapy in military and civilian settings, reducing 24-hour and 30-day mortality by preserving clotting factors and minimizing dilution; a 2022 review of studies showed LTOWB associated with fewer transfusions and better hemostasis in massively bleeding patients.^[83] Timing is critical: administration within 1 hour of injury correlates with halved mortality odds in severe hemorrhage cases.^[84] Resuscitative endovascular balloon occlusion of the aorta (REBOA) provides temporary proximal aortic control for non-compressible torso hemorrhage, redirecting blood flow to vital organs during exsanguination.^[85] Inserted via femoral access and inflated in zones I or III of the aorta, REBOA stabilizes hemodynamics in profound shock, with military data from 2014-2019 indicating feasibility and short-term survival gains in select cases.^[86] However, a 2023 randomized trial found no mortality benefit over standard resuscitation, citing complications like distal ischemia and reperfusion injury, limiting its routine use to centers with expertise and as a bridge to definitive surgery.^[87] Recent protocols advocate an "x-ABC" sequence—extremity hemorrhage control (X) before airway (A) and breathing (B)—for exsanguinating patients, supported by evidence that delaying circulation prioritization increases mortality from uncontrolled bleeding.^[88] Prehospital advancements, including whole blood and TXA deployment via helicopter services, have extended these strategies, with Scandinavian studies from 2022 showing reduced transport mortality through early blood product use.^[89] Overall, these integrated advances have lowered trauma mortality from hemorrhage, though outcomes depend on rapid implementation and institutional protocols.

Surgical and Hemostatic Interventions

In trauma-induced exsanguination, extremity tourniquets are a primary hemostatic intervention to rapidly occlude arterial blood flow and prevent further blood loss from compressible wounds. Studies in civilian settings demonstrate that tourniquet application effectively halts bleeding in cases of blunt or penetrating extremity trauma, reducing mortality from exsanguination.^[90] Prehospital tourniquet use has been shown to reliably stop limb hemorrhage and is associated with low complication rates when applied briefly, supporting its role in initial stabilization before surgical access.^[91] Topical hemostatic agents, such as chitosan-based dressings like ChitoGauze, provide adjunctive control for non-compressible or junctional hemorrhage by promoting clot formation through platelet activation and absorption of fluids. Clinical evaluations indicate these agents achieve hemorrhage cessation in approximately 70% of prehospital applications, with reduced bleeding in an additional 20% of cases, though efficacy varies by wound severity and coagulopathy.^[92] Other agents, including zeolite or kaolin-impregnated gauze, accelerate coagulation but require direct pressure and are most effective for low-pressure venous bleeding rather than high-velocity arterial sources.^[93] Surgical interventions prioritize damage control surgery (DCS) in patients with physiologic derangement, such as hypothermia below 35°C, base deficit exceeding -14, or coagulopathy, to abbreviate laparotomy and focus on hemorrhage control over definitive repair. DCS involves rapid techniques like perihepatic packing, vascular shunting, or temporary abdominal closure to minimize operative time and allow resuscitation in intensive care, yielding improved survival rates in exsanguinating penetrating abdominal injuries compared to traditional exhaustive surgery.^[94]^[1] For vascular injuries, definitive hemostasis employs vessel ligation, endovascular embolization, or balloon tamponade, often integrated into DCS protocols to address specific bleeding sites while staging reconstruction.^[95] In exsanguinating torso trauma, prioritizing circulatory control via DCS before airway interventions has been linked to lower mortality, emphasizing early source occlusion over standard ABC sequencing.^[7] These approaches, combined with permissive hypotension and balanced transfusion, form the core of modern hemostatic strategies to interrupt the lethal triad of acidosis, hypothermia, and coagulopathy.^[96]

Forensic and Historical Contexts

Autopsy Diagnosis and Homicide Cases

In forensic pathology, exsanguination is diagnosed at autopsy primarily through the identification of traumatic injuries to major blood vessels, corroborated by gross and microscopic evidence of acute hypovolemia. External examination reveals incised or stab wounds transecting arteries such as the carotid, femoral, or axillary, often with patterned hemorrhage or cast-off blood trails indicating arterial spurting. Internal dissection shows the "empty heart" sign, characterized by collapsed cardiac chambers with scant residual blood, a finding linked to rapid exsanguination from vascular rupture rather than agonal emptying alone.^[97] ^[98] This is distinguished from postmortem settling by the absence of clot formation in vessels and pale, bloodless viscera, reflecting total blood loss exceeding 40% of circulating volume (approximately 2 liters in adults).^[99] Quantification of blood loss occurs via direct measurement of free intraperitoneal, pleural, or pericardial blood during evisceration, supplemented by weighing organs to assess dehydration from hypovolemic shock; losses over 1.5-2 liters correlate with fatal outcomes absent intervention.^[99] Postmortem computed tomography (PMCT) aids diagnosis by demonstrating reduced organ density (e.g., lung attenuation dropping below -200 Hounsfield units) and collapsed great vessels like the superior vena cava or pulmonary artery, which blanch due to depleted intravascular volume.^[100] ^[101] Histology may reveal early agonal changes such as centrilobular liver necrosis or renal tubular dilation from hypoperfusion, but these are absent in perimortem exsanguination where death ensues within minutes.^[102] In homicide investigations, exsanguination frequently results from sharp force trauma, accounting for a significant portion of stabbing fatalities where multiple wounds target vital arteries to accelerate death.^[103] Forensic differentiation from suicide hinges on wound multiplicity (homicides often exceed 5-10 incisions/stabs versus 1-3 in suicides), absence of hesitation marks, and presence of defense injuries like parallel linear abrasions on palms or forearms from warding off attacks.^[104] ^[105] Neck stabbings, severing the common carotid or jugular veins, exemplify homicidal intent due to their lethality (survival under 5 minutes without pressure) and rarity in self-inflicted cases owing to anatomical access challenges.^[106] ^[107] Notable cases include a 2022 autopsy of a thigh incision by a Japanese short sword transecting the femoral artery, ruled homicide based on wound angle inconsistent with self-infliction and lack of suicidal history; exsanguination occurred via 1.5-2 liter external loss.^[108] Overkill stabbings, as in a 2024 Italian case with 11 thoracic and abdominal penetrations causing combined visceral and vascular hemorrhage, underscore homicidal aggression, with blood spatter analysis confirming assailant proximity.^[109] Challenges arise in "staged" suicides mimicking homicide, resolved via toxicology (absence of incapacitating drugs) and scene reconstruction, emphasizing multidisciplinary autopsy protocols to prevent misclassification.^[110]^[103]

Historical Understanding and Evolution

Ancient physicians, including Hippocrates (c. 460–370 BCE), identified exsanguination as a primary mechanism of death from severe external or internal hemorrhage, particularly in battlefield wounds or rudimentary surgeries, though causal attributions relied on humoral theory positing blood loss as a depletion of vital fluids rather than circulatory insufficiency.^[111] This framework dominated until the 17th century, when William Harvey's 1628 treatise De Motu Cordis demonstrated systemic blood circulation, reframing exsanguination as a failure to maintain perfusion rather than mere humoral imbalance.^[112] Early experiments followed, such as Richard Lower's 1667 inter-animal blood transfusion, which successfully reversed exsanguination-induced collapse in dogs by restoring volume, laying groundwork for recognizing hypovolemia's role.^[112] The 18th and 19th centuries saw incremental progress amid the waning of bloodletting—discredited as a cure-all by the late 1800s for exacerbating hemorrhage.^[113] In 1731, surgeon Henri Francois Le Dran described "shock" as circulatory collapse following injury, distinguishing it from simple blood loss.^[112] James Blundell's 1818 human-to-human transfusion for postpartum exsanguination demonstrated practical volume replacement, while Thomas Latta's 1832 intravenous saline infusions for cholera hypovolemia empirically validated fluid therapy against decompensated hemorrhage, shifting focus toward physiological restoration over humoral rebalancing.^[112] World War I accelerated causal realism in understanding exsanguination, as physiologist Walter B. Cannon's frontline studies rejected prevailing toxin-absorption theories, instead attributing most traumatic shock to hypovolemic blood loss causing acidosis and organ failure, and recommending early saline resuscitation to avert death.^[114]^[115] By 1934, Alfred Blalock classified hypovolemic shock distinctly as hemorrhage-driven volume deficit, integrating it into broader shock taxonomies.^[112] Postwar innovations, including widespread blood banking and invasive monitoring from the 1940s onward, evolved treatment toward balanced resuscitation, culminating in 21st-century damage control strategies that prioritize hemostasis and limited fluids to counter coagulopathy and reperfusion injury in exsanguinating trauma.^[112]^[116]

References

[1]
Managing exsanguination: what we know about damage control ...
Asensio (1–4) has described it as the most extreme form of hemorrhage, with an initial blood loss of >40% and ongoing bleeding that, if not surgically ...
[2]
Management of Hemorrhagic Shock: Physiology Approach, Timing ...
Dec 29, 2022 · 4. Cardiac Arrest by Exsanguination—Stage V. Cardiac arrest (CA) by exsanguination occurs when more than 40% of the total blood volume (TBV) ...
[3]
Hemorrhagic Shock - StatPearls - NCBI Bookshelf
Class 3: Volume loss from 30% to 40% of total blood volume, from 1500 mL to 2000 mL. A significant drop in blood pressure and changes in mental status occurs.
[4]
Exsanguination - an overview | ScienceDirect Topics
Exsanguination is defined as a severe loss of blood, which may occur due to complications such as massive hemoptysis, hematemesis, or hematochezia, particularly ...Extremity Tourniquets · Systemic Effects · Intraoperative Catastrophes
[5]
Clinical review: Hemorrhagic shock - PMC - PubMed Central
This review addresses the pathophysiology and treatment of hemorrhagic shock – a condition produced by rapid and significant loss of intravascular volume, ...
[6]
Prehospital Hemorrhage Control and Treatment by Clinicians
Exsanguination remains the leading cause of preventable death among victims of trauma, with nearly half of these patients dying in the prehospital setting.
[7]
Prioritizing circulation over airway to improve survival in trauma ...
Jun 2, 2025 · Prioritizing circulation over airway management in trauma patients with exsanguinating injuries significantly reduces mortality compared to the traditional ABC ...
[8]
Damage control resuscitation - PMC - NIH
Mar 31, 2020 · Damage control involves three phases: control of life-threatening hemorrhage and contamination followed by more complete resuscitation and ...Pathophysiology · Tenets Of Dcr · Thromboelastography
[9]
Hypovolemia and Hypovolemic Shock - StatPearls - NCBI Bookshelf
Jun 1, 2025 · Hemorrhagic shock most commonly arises from trauma, followed by gastrointestinal bleeding, but can also result from intraoperative or ...
[10]
Hemorrhagic Shock: Practice Essentials, Pathophysiology ...
Sep 5, 2023 · Acute hemorrhage causes a decreased cardiac output and decreased pulse pressure. These changes are sensed by baroreceptors in the aortic arch ...Practice Essentials · Pathophysiology · Epidemiology
[11]
Pathophysiology of hemorrhagic shock - Kuo - Wiley Online Library
Jan 19, 2022 · Hemorrhagic shock is a common condition that may lead to hemodynamic instability, decreased oxygen delivery, cellular hypoxia, organ damage, and ultimately ...Abstract · Anemia · Systemic Response to Acute... · Compensated Hemorrhagic...
[12]
Reliable variables in the exsanguinated patient which ... - PubMed
Mortality was 379 of 548 (69%). Predictive factors for mortality (means): pH < or =7.2, temperature <34 degrees C, OR blood replacement >4,000 mL, total OR ...
[13]
Exsanguination in trauma: A review of diagnostics and treatment ...
Haemorrhage is responsible for 30–40% of trauma mortality and of these deaths, 33–56% occur during the prehospital period. Only central nervous system injury, ...
[14]
Impact of Hemorrhage on Trauma Outcome: An Overview of... - LWW
Hemorrhage is responsible for 30 to 40% of trauma mortality, and of these deaths, 33 to 56% occur during the prehospital period.
[15]
The Why & How Our Trauma Patients Die: A Prospective Multicenter ...
The most common overall primary COD was TBI (45%), followed by exsanguination (23%). TBI was non-survivable in 82.2% of cases. Blunt patients were more likely ...
[16]
Epidemiology of Trauma-Related Hemorrhage and Time to ...
Oct 2, 2023 · The most common types of blunt trauma were motor vehicle injuries (83.5%), followed by falls (9.3%), with assaults, incidents due to machinery, ...
[17]
Traumatic injury to the great vessels of the chest - Mediastinum
The most common anatomic site of injury or tear in BTAI occurs at the aortic isthmus, on the medial luminal aspect of the descending thoracic aorta, distal to ...
[18]
Trauma Patients Who Exsanguinated Due to Peripheral Injury ... - NIH
Sep 18, 2025 · Trauma patients may die of external bleeding from junctional or peripheral injuries. Most peripheral injuries are compressible allowing for ...Missing: peer | Show results with:peer
[19]
Prognostic predictors of early mortality from exsanguination in adult ...
May 31, 2017 · In a Malaysian trauma center, age, SBP, core body temperature, intra-abdominal injury and NISS were significant predictors of early death from exsanguination.
[20]
Mortality from isolated civilian penetrating extremity injury - PubMed
This study examined the treatment course and outcomes of civilian patients who appear to have exsanguinated from isolated penetrating extremity injuries.
[21]
Meta Analysis on Mortality of Ruptured Abdominal Aortic Aneurysms
Overall mortality was 48.5% (95% CI: 48.1–48.9%) and did not change significantly over the years. Age increased over the years. For overall mortality a trend ...Missing: exsanguination | Show results with:exsanguination
[22]
Upper Gastrointestinal Bleeding - StatPearls - NCBI Bookshelf - NIH
Aug 17, 2024 · Upper gastrointestinal bleeding (UGIB) is a common problem with an annual incidence of approximately 80 to 150 per 100000 population, ...Missing: exsanguination | Show results with:exsanguination
[23]
Exsanguinating upper GI bleeds due to Unusual Arteriovenous ...
May 1, 2009 · Dieulafoy's Lesion (DL) is an uncommon cause of gastric bleeding. It accounts for less than 5% of all gastrointestinal bleeds in adults [2].
[24]
Fatal exsanguination from hemodialysis vascular access sites
Dec 13, 2011 · In these instances, the common causes of kidney failure included hypertensive cardiovascular disease and diabetes mellitus. The manners of ...
[25]
Iatrogenic operative injuries of abdominal and pelvic veins
The purpose of this study was to review the management and clinical outcome in patients with operative injuries to abdominal and pelvic veins.
[26]
Exsanguination from ruptured femoral artery pseudoaneurysm – A ...
Jun 14, 2022 · In contrast to iatrogenic cases, grafts and revascularization are inadvisable because of sustained infection due to poor hygiene and nonsterile ...
[27]
Exsanguination from an arteriovenous dialysis fistula
Feb 24, 2025 · Forensic medical examination concluded that death was caused by bleeding from an arteriovenous dialysis shunt vessel as a complication of ...
[28]
Exsanguination from arteriovenous fistula: anything is possible!
Mar 3, 2020 · Kutschera et al. described another case in which the cause of death was exsanguination, and the manner of death was accidental and iatrogenic, ...Missing: literature | Show results with:literature
[29]
Postpartum Hemorrhage - StatPearls - NCBI Bookshelf - NIH
Jul 19, 2024 · Postpartum hemorrhage (PPH) poses a significant risk to maternal health and is characterized by excessive blood loss after delivery.
[30]
[PDF] Pathophysiology of Postpartum Hemorrhage and Third Stage of Labor
... PPH can lead to exsanguination within a short time. Whilst uterine atony is responsible for 75–90% of primary PPH, traumatic causes of primary PPH.
[31]
Postpartum Hemorrhage: Overview, Etiology, Diagnosis
Jan 23, 2025 · The underlying causes of PPH are often described using the “Four T's”: tone, tissue, trauma, and thrombin.
[32]
DIC in Pregnancy – Pathophysiology, Clinical Characteristics ...
Jan 6, 2022 · DIC in obstetrics is a life-threatening complication that is secondary to obstetrical and non-obstetrical related complications of pregnancy.
[33]
Imaging of Antepartum and Postpartum Hemorrhage - RSNA Journals
Mar 28, 2024 · The purpose of this article is to review the manifestations and causes of antepartum and postpartum hemorrhage, review therapeutic options, and emphasize the ...Missing: pathophysiology | Show results with:pathophysiology
[34]
Incidence and Risk Factors for Postpartum Hemorrhage - NIH
Jun 15, 2023 · Known risk factors for PPH are prolongation of labor, multiple gestations, multiparity, fetal macrosomia, operative vaginal delivery, uterine ...
[35]
Postpartum Hemorrhage Trends and Outcomes in the United States ...
Jan 1, 2023 · Conclusion: Postpartum hemorrhage and related risk factors increased over a 20-year period. Despite the increased postpartum hemorrhage rates, ...Missing: causes | Show results with:causes
[36]
Postpartum haemorrhage - World Health Organization (WHO)
Severe bleeding after childbirth - postpartum haemorrhage (PPH) - is the leading cause of maternal mortality world-wide.
[37]
Hemorrhage Causes Most Maternal Deaths Worldwide
Apr 11, 2025 · Obstetric hemorrhage remains the leading cause of maternal mortality, accounting for about 27% of deaths during pregnancy and the following 6 weeks, a new ...
[38]
Postpartum Hemorrhage - PMC - PubMed Central - NIH
Apr 29, 2021 · Worldwide, postpartum hemorrhage accounts for 8% of maternal deaths in developed regions of the world and 20% of maternal deaths in developing ...Missing: incidence | Show results with:incidence
[39]
Postpartum Hemorrhage - ACOG
The purpose of this Practice Bulletin is to discuss the risk factors for postpartum hemorrhage as well as its evaluation, prevention, and management.Missing: exsanguination | Show results with:exsanguination
[40]
Prognostic accuracy of clinical markers of postpartum bleeding in ...
Oct 4, 2025 · Postpartum haemorrhage remains a leading cause of maternal mortality globally, despite the availability of effective treatments. Early ...
[41]
Mechanical, electrical or gas stunning; slaughter methods and ...
Apr 17, 2019 · The outcome of stunning prior to slaughter is to render the animal unconscious such that it is insensible to any pain and distress associated with the cutting ...
[42]
Stunning Methods - an overview | ScienceDirect Topics
The first two steps of slaughter are comprised of two processes: stunning and exsanguination (blood released from the circulatory system). Stunning is designed ...
[43]
Bleeding - Humane Slaughter Association
The stun-to-stick interval is the time from application of stunning equipment to the start of bleeding. A maximum stun-to-stick interval of 15 seconds is ...
[44]
LAB 1.3 Stunning, Exsanguination & Evisceration
The exsanguination or sticking of meat animals in an abattoir is usually performed by severing the carotid arteries and the jugular vein at the base of the neck ...
[45]
Challenges of Killing and bleed-out – BAADER Poultry
During the bleeding process, the objective is to remove 45-50% of the total blood volume, which is approximately 3% of the live body weight. The primary purpose ...
[46]
Bleeding Efficiency and Meat Oxidative Stability and Microbiological ...
Poor bleeding efficiency can negatively affect colour of the meat and is considered to be a major quality defect, which can even cause undesirable ...
[47]
Influence of Different Bleeding Times on Structural and ...
Jun 28, 2025 · The results obtained from this study suggest that a 15-min bleeding duration improves bleeding efficiency and without compromising beef chemical and colour ...
[48]
Bleeding Line | DGS | Efficient and Animal-Friendly Slaughter
DGS systems ensure fast and complete bleeding, contributing to humane slaughtering practices and enhancing meat quality.
[49]
Bleeding Efficiency, Microbiological Quality and Oxidative Stability of ...
Apr 1, 2016 · Bleeding efficiency is an essential requirement of slaughter procedures in order to obtain a high quality product. Blood loss is a major concern ...
[50]
A Review of Different Stunning Methods for Poultry—Animal Welfare ...
Nov 30, 2015 · Electrical water bath stunning is the most commonly used method for poultry stunning prior to slaughter, but has been questioned on animal ...
[51]
[PDF] AVMA Guidelines for the Humane Slaughter of Animals: 2024 Edition
methods; clear industry policies regarding the treat- ment of injured ... other method such as exsanguination. Many species may exhibit hyperactivity ...
[52]
Religious slaughter and animal welfare:a discussion for meat ...
Both the Muslim and Jewish faiths have specific requirements for the slaughter of religiously acceptable animals.
[53]
Evaluation of the animal welfare during religious slaughtering - PMC
The Halal method also tolerates post-slaughter stunning, so as to prevent uncontrolled movements after animal exsanguination. The Jewish religion requires a ...
[54]
Religious slaughter: A current controversial animal welfare issue
Jul 1, 2012 · Significant numbers of Muslim and Jewish people demand meat products from animals killed using practices according to religious requirements.
[55]
Kosher and Halal Slaughter | Oklahoma State University
Kosher and halal are two distinct types of ritual slaughter observed by people practicing Jewish and Muslim religions, respectively (Barry, 2014).Missing: exsanguination | Show results with:exsanguination
[56]
Stunning Compliance in Halal Slaughter: A Review of Current ...
Sep 29, 2023 · Scientific findings suggest that halal-compliant stunning technologies are reversible, do not kill animals prior to the halal cut, and do not obstruct blood ...
[57]
Halal and kosher slaughter methods and meat quality: A review
Halal and kosher slaughter practices per se do not affect meat quality more than their conventional equivalents.
[58]
Welfare indicators for stunning versus non-stunning slaughter in ...
Jul 2, 2022 · Conclusions: This study provides further evidence that stunning is an effective method to improve the welfare of sheep and cattle at slaughter.
[59]
Indicators used in livestock to assess unconsciousness after stunning
Oct 30, 2014 · Cattle lose spontaneous brain activity 75±48 s post neck cut (range 19 to 113 s), but Newhook and Blackmore (1982) suggested possible ...
[60]
Assessment of unconsciousness during slaughter without stunning ...
The stress level of cattle before being slaughtered will be shown at the time after the slaughtering process, which includes the time to stop blood gushing and ...Missing: unstunned dhabihah
[61]
Rapid loss of consciousness in cattle following nonstun slaughter
Nonstun slaughter (NSS) of bovines involves ventral neck incisions, resulting in an abrupt loss of cortical blood flow and causing nearly instantaneous loss of ...
[62]
Welfare indicators for stunning versus non‐stunning slaughter in ...
Jul 2, 2022 · All seven studies measuring consciousness after the cut reported there was increased prevalence of the corneal reflex (n = 3), palpebral reflex ...<|separator|>
[63]
Welfare of cattle at slaughter - - 2020 - EFSA Journal - Wiley
Nov 3, 2020 · To monitor stunning method efficacy, the state of consciousness of the animals should be checked immediately after stunning, just prior to neck ...
[64]
Slaughter of cattle without stunning: Questions related to pain, stress ...
Most of the time, slaughter involves two interventions: first, the animal is stunned to induce unconsciousness and second, the animal is exsanguinated to induce ...
[65]
Animals, Stress, And Kosher Slaughter - Faunalytics
Nov 22, 2018 · Measurment of stress hormones reveals that kosher slaughtered cows endure highly elevated levels of stress during slaughter.
[66]
Conventional versus Ritual Slaughter–Ethical Aspects and Meat ...
Animals intended for ritual slaughter showed lower levels of cortisol and catecholamines on the farm and after transport to the slaughterhouse. The authors ...
[67]
Patterns of wrist cutting: A retrospective analysis of 115 suicide ... - NIH
May 15, 2020 · We conducted a retrospective study involving 115 patients who had cut their wrists and been examined at the emergency department of a single hospital in Seoul, ...Missing: prevalence | Show results with:prevalence
[68]
A pilot study of 17 wrist-cutting suicide injuries in single institution
Mar 31, 2021 · On average, there are 20–25 suicide attempts for every completed suicide, frequently by self-inflicted wrist cutting [4]. In the United States, ...<|separator|>
[69]
Case report Medical suicide – Groin stabbing - ScienceDirect.com
This case report concerns a 50-year-old male who died from exsanguination due to self-inflicted stabbing injuries to the groin and cutting injuries to the neck.
[70]
[Suicide by cutting the radial artery of the wrist. Report of 2 cases].
Suicide attempts made by cutting the wrist artery (A. radialis et ulnaris) are usually unsuccessful if the vessel wall or blood clotting has not changed ...Missing: common neck femoral<|control11|><|separator|>
[71]
A rare suicide case involving fatal bleeding from varicose veins
Jun 10, 2021 · Sharp force suicides account only for 1.6–3% of all suicides. Fatal bleeding from the peripheral vascular system is a rare condition. Varicose ...
[72]
Systematic analysis of nonfatal suicide attempts and further ... - NIH
Oct 2, 2023 · The most common methods were intoxication (n = 1101, 51.8%), cutting (n = 461, 21.7%), and strangulation (n = 183, 8.6%).Missing: involving | Show results with:involving
[73]
The Noble Suicide: The Case of a Self-Contained Dagger in the ...
Mar 19, 2024 · According to WHO estimates, more than 700000 people die each year due to suicide and suicides performed with a bladed weapon account for ...
[74]
The lethality of suicide methods: A systematic review and meta ...
Mar 1, 2022 · Firearms were found to be the most lethal method (CFR:89.7%), followed by hanging/suffocation (84.5%), drowning (80.4%), gas poisoning (56.6%), jumping (46.7%).
[75]
A pilot study of 17 wrist-cutting suicide injuries in single institution
Mar 31, 2021 · We aim to understand the characteristics of self-inflicted wrist injuries and share the perspectives from a hand surgeon in order to inform those who face ...Missing: prevalence | Show results with:prevalence
[76]
Bleeding to Death: Am I at Risk, and How Can I Stop It? - Healthline
Apr 11, 2018 · Bleeding to death, or exsanguination, isn't common. Exsanguination is often the result of blood loss from an injury. But blood loss isn't ...
[77]
https://pubmed.ncbi.nlm.nih.gov/34953923
[78]
[PDF] Damage Control Resuscitation, 29 Aug 2023 - Joint Trauma System
Aug 29, 2023 · Advanced Trauma Life Support (ATLS) guidelines historically advocated a linear resuscitation strategy beginning with an emphasis on crystalloid ...<|separator|>
[79]
Damage Control Resuscitation - PMC - PubMed Central
The aim of damage control surgery is to stop hemorrhage and minimize contamination. Temporary clamping, packing, shunting, or ligation controls hemorrhage, and ...
[80]
Permissive Hypotension - StatPearls - NCBI Bookshelf - NIH
Mar 1, 2024 · Permissive hypotension is a deliberate strategy to maintain blood pressure at lower-than-normal levels in patients with trauma or hemorrhage.
[81]
Permissive hypotension • LITFL • CCC Resuscitation
Permissive hypotension is also known as hypotensive resuscitation and low volume resuscitation. The concept remains controversial and is primarily ...
[82]
Permissive Hypotension vs. Conventional Resuscitation in Patients ...
Jul 19, 2021 · Permissive hypotension limits blood loss while maintaining adequate perfusion and positively impacts outcomes in actively hemorrhaging trauma ...
[83]
The Use of Whole Blood Transfusion in Trauma - PMC - NIH
Jan 17, 2022 · Many studies show that compared to Component Therapy, Low Titer O Whole Blood transfusion is associated with better patient outcomes and simplified transfusion ...
[84]
Timing to First Whole Blood Transfusion and Survival After Severe ...
Jan 31, 2024 · Whole-blood resuscitation has been associated with a reduction in 24-hour and 30-day mortality in trauma populations. Recent evidence showed ...
[85]
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA ...
Jan 29, 2022 · REBOA during CPR increases cerebral and coronary perfusion pressure by increasing the afterload of the left ventricle, thus improving the ...
[86]
[PDF] Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA ...
Mar 31, 2020 · This CPG reviews the range of accepted management approaches for Resuscitative Endovascular Balloon. Occlusion of the Aorta (REBOA) as a ...<|separator|>
[87]
Emergency Department Resuscitative Endovascular Balloon ...
Oct 12, 2023 · This randomized clinical trial compares the effectiveness of resuscitative endovascular balloon occlusion of the aorta and standard care in ...
[88]
x-ABC versus ABC: shifting paradigms in early trauma resuscitation
Apr 14, 2025 · In this review, we examine the history and evolution of the ABCs in the context of resuscitation research to the recent adoption of x-ABC in trauma.
[89]
Advanced interventions in the pre-hospital resuscitation of patients ...
Jun 20, 2022 · Early haemorrhage control and minimizing the time to definitive care have long been the cornerstones of therapy for patients exsanguinating ...
[90]
Tourniquet use for peripheral vascular injuries in the civilian setting
Conclusions: Tourniquets may prevent exsanguination in the civilian setting for patients suffering either blunt or penetrating trauma to the extremity.
[91]
Tourniquet use for treatment of vascular trauma in civilian casualties ...
Tourniquet use reliably stops bleeding from limb wounds and prevents mortality in prehospital settings; moreover, brief tourniquet use appears to be safe.
[92]
Hemostatic agents for prehospital hemorrhage control: a narrative ...
Mar 25, 2020 · A prospective study of 66 cases of prehospital use of ChitoGauze showed approximately 70% cessation of hemorrhage and 20% reduced hemorrhage ...
[93]
Overview of Agents Used for Emergency Hemostasis - PMC - NIH
Hemostatic agents can play a key role in the emergency control of hemorrhage following various types of trauma and will decrease the associated mortality and ...
[94]
'damage control': an approach for improved survival in ... - LWW
We conclude that damage control is a promising approach for increased survival in exsanguinating patients with major vascular and multiple visceral penetrating ...
[95]
[PDF] Management of Exsanguinating Patients in Trauma
These authors depicted a 'bloody vicious cycle' in which hemorrhage, cellular shock and tissue injury contrib- ute to the formation of the lethal triad which ...
[96]
Damage Control Surgery for Abdominal Trauma - PMC - NIH
Damage Control as practised today has three separate components. Phase I consists of abbreviated laparotomy for rapid control of haemorrhage and contamination.
[97]
Exsanguination from impact head trauma - ScienceDirect.com
These findings demonstrate that the “empty heart” sign is merely an indication of exsanguination due to basilar skull fracture.
[98]
Exsanguination from impact head trauma; the explanation ... - PubMed
The "empty heart" sign is merely an indication of exsanguination due to basilar skull fracture. The mechanism of exsanguination in these cases is discussed.Missing: diagnosis | Show results with:diagnosis
[99]
Relative blood loss in forensic medicine—do we need a change in ...
Mar 6, 2020 · Autopsy findings. The estimation of blood loss is part of routine autopsy in which free blood quantities are collected from the body cavities ...Missing: diagnosis | Show results with:diagnosis
[100]
Effects of blood loss on organ attenuation on postmortem CT and ...
Nov 24, 2021 · Blood loss decreases organ weight and CT attenuation of the lungs but appears to have no significant effect on CT attenuation of the spleen and kidneys.
[101]
Postmortem Radiology of Fatal Hemorrhage: Measurements of ...
Most cases with a cause of death of “fatal hemorrhage” had collapsed vessels. The finding of a collapsed superior vena cava, main pulmonary artery, or right ...
[102]
Exsanguination in an 18-year-old woman who died in a car accident ...
Death by exsanguination causes vessels to collapse more than usual, even the thoracic aorta, and it reduces the heart size.
[103]
Forensic Autopsy of Sharp Force Injuries - Medscape Reference
May 26, 2025 · The most common manner of death associated with sharp force trauma is homicide, followed by suicide. Accidental sharp force injury fatalities do ...
[104]
Differentiating suicide from homicide in sharp-force fatalities with ...
Thus, distinguishing suicidal stab and/or incised wounds from homicidal stab and/or incised wounds is significant from the forensic perspective. This scoping ...Missing: exsanguination slashing
[105]
Pattern and Forensic Significance of Defense Injuries in Homicide ...
Mar 3, 2025 · Data was collected from autopsy reports, crime scene records, and inquest papers over a five-year period at a tertiary care hospital and ...Missing: exsanguination slashing
[106]
Penetrating two stab to the throat, survival time and physical mobility
Dec 18, 2023 · The rate of all suicide cases resulting from sharp-force injury is 1.91–3%. Males are more likely to sustain sharp force neck injuries during ...
[107]
Death by artery injury: two peculiar cases of sharp force fatality
... forensic pathologists are often asked to investigate deceased victims of stab wounds. Moreover, homicide by sharp force (stabbing) is one of the most common ...
[108]
A Case of Fatal Exsanguination by a Japanese Short Sword
Aug 6, 2025 · Autopsy revealed an incised wound extending diagonally from superolaterally to inferomedially on the anterior left thigh as the only injury. The ...
[109]
[PDF] overkilling by stabbing and suicide by hanging Case Reports
Case report. On a Sunday afternoon, a 52 year old man killed his 43 year old partner in their home with eleven stab wounds. A few.
[110]
[PDF] Stab wound suicide mimicking homicide: a forensic case report - HAL
Apr 18, 2025 · Keywords: Suicide, Wounds, Stab, Autopsy, Forensic Medicine, Crime Scene. Investigation. Introduction. Suicide is a major public health issue (1) ...Missing: exsanguination | Show results with:exsanguination
[111]
Bloodletting: Why doctors used to bleed their patients for health
Nov 16, 2020 · Some sources suggest that the original practice of bloodletting is more than 3,000 years old and that the Ancient Egyptians, Greeks, and Romans ...
[112]
The History of Fluid Resuscitation for Bleeding - PMC
Richard Lower conducted research in the cardiopulmonary system and was the first to describe the difference in blood after exposure to air via the lungs. In ...
[113]
The history of bloodletting | British Columbia Medical Journal
With a history spanning at least 3000 years, bloodletting has only recently—in the late 19th century—been discredited as a treatment for most ailments.
[114]
Walter B. Cannon's World War I experience: treatment of traumatic ...
Jun 1, 2018 · Subsequently, Cannon performed animal experimentation on the causes of traumatic shock in the London laboratory of Dr. William Bayliss before ...
[115]
Introduction - Fluid Resuscitation - NCBI Bookshelf
In his 1923 landmark work, Walter Cannon summarized the World War I experience and concluded that shock most often resulted from intravascular volume deficits ...
[116]
https://doi.org/10.1016/j.ccc.2008.12.013