A 14-year-old boy is brought to the ED following a high-speed cycling accident where he sustained a handlebar injury to his abdomen. A splenic rupture is suspected. His parents are Jehovah's Witnesses and refuse all blood products on his behalf. The treating team feel a blood transfusion may be required if his bleeding continues. The boy states he agrees with his parents and explicitly refuses a transfusion.
Observations: HR 128, RR 24, SpO₂ 98% on air, BP 95/60. Examination: Pale, alert, and speaking in short sentences. He has significant left upper quadrant tenderness.
What is the most appropriate action regarding a potential transfusion?
Accept refusal as both patient and parents agree
Transfuse immediately without further assessment
Apply for emergency court order before any deterioration
Resuscitate without blood, seek court order if needed
Accept parental refusal, document and proceed without blood