Bleeding

Exam Cram

• Bleeding can present as a medical emergency, typically a variceal upper GI bleed

• If severe- senior support, HDU/ ICU setting and A-E initially performed

• Aim to blood with blood, consider massive transfusion protocol and reversal agents

• Consider underlying cause, e.g. malignancy or haemophilia

Overview

Lists

Sources of blood loss (head to toe):

• • Haematoma - intracranial or elsewhere

  • Intracranial haemorrhage

  • Epistaxis, bleeding gums

  • Haemoptysis

  • Haemothorax

  • Haemopericardium

  • Hematemesis and hematochezia (blood in stool)

  • Haematuria

  • Skin lacerations

  • Long bone fractures

Factors

• Trauma/ Atraumatic

• Coagulopathy

  • Congenital Haemophilias

  • Acquired- thrombocytopenia ,coagulopathies

  • Iatrogenic- anticoagulants, antiplatelets etc

• Operations, procedures

Core Conditions

• Upper GI Bleed, Lower GI bleed

• Haemorrhagic stroke, subdural/ epidural haematoma

• Urological cancer- bladder, renal

• Trauma, operations & PPH

• Haemophilia, Von WilleBrand Disease

• DIC, TTP, HUS, HIT

• Osteoporosis

Management

Acute

1. Stabilise: 

   • Manage in appropriate setting, e.g. HDU

   • A-E assessment, 

   • Escalate, ask for help, consider peri-arrest buzzer

   • Consider 0 negative blood, reversal agents and massive transfusion protocol

   • Consider IVF

2. Assess underlying cause

   • Malignancy screen

   • Haemophilia screen

   • Assess antiplatelets and anticoagulants

Resources and References

Written in 2025