Figure 47-3 This algorithm for diagnosing and treating a massive transfusion was modified from the massive transfusion protocol used at the San Francisco General Hospital. There are many other similar approaches; Figure 47-7 provides an algorithm for a pure coagulation. This protocol suggests how to approach a patient with major blood loss but does not include the use of recombinant activated factor VII, which may be possible in the future.^[75] BP, blood pressure; CBC, complete blood cell count; EBV, effective blood volume; ED, emergency department; FFP, fresh frozen plasma; Hct, hematocrit; INR, international normalized ratio; PC, platelet count; PRBC; packed red blood cells; PT, prothrombin time; PTT, partial thromboplastin time.