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| {{SI}} | | __NOTOC__ |
| | {{Bleeding}} |
| | '''For patient information, click [[Bleeding (patient information)|here]].''' |
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| {{CMG}} | | {{CMG}} |
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| {{EH}}
| | ==[[Bleeding overview|Overview]]== |
| ==[[Overview]]== | |
| ==[[Causes, prevalence, and risk factors]] ==
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| ==[[Types of bleeding]]== | | ==[[Bleeding classification|Classification]]== |
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| == Bleeding definition for the Cardiovascular Trials== | | ===Bleeding Classified by Severity=== |
| ===Overview===
| | [[Bleeding classification#American College of Surgeons' Advanced Trauma Life Support (ATLS) Scheme|Advanced Trauma Life Support (ATLS) Scheme]] |
| The incidence of [[bleeding]] complications varies from 1% to 10% during treatment of [[acute coronary syndromes]] ([[ACS]]) and [[PCI]] ([[Percutaneous coronary intervention]]). This is in part due to use of combination of multiple drugs like [[aspirin]], [[heparin]], [[warfarin]], [[platelet P2Y12 inhibitors]], [[glycoprotein IIb/IIIa inhibitors]], [[direct thrombin inhibitor]] and also the invasive procedures (percutaneous coronary intervention, [[Coronary artery bypass graft]]) during this period. Also, the bleeding complications have been found to be associated with increase in incidence of short and long term adverse outcomes like death, non-fatal [[MI]] (myocardial infarction), [[stroke]] and [[stent thrombosis]]. The exact mechanism underlying this is not clearly defined but may be due to the cessation of evidence based therapies (like [[antiplatelet]], [[Beta blockers]], [[statin]]), effect of[[ blood transfusion]], co morbidities and [[anemia]] that are seen more in patients with bleeding complications. Therefore, bleeding presents as an important safety endpoint in many of the cardiovascular trials.
| | | [[Bleeding classification#World Health Organization|World Health Organization scale]] |
| However, there is a lack of uniformity in the definitions of bleeding that could be used in the cardiovascular trials that in turn make it difficult to conduct and compare the results of different trials. Several bleeding definitions have been used in different clinical trials – [[TIMI]], [[GUSTO]], [[CURE]], [[ACUITY HORIZONS]], [[CURRENT OASIS]], [[STEEPLE]], [[PLATO]], [[GRACE]], [[ISAR-REACT3]], [[ESSENCE]], [[Amlani. et.al]]. .To decrease the heterogeneity and to adopt standardized bleeding end-point definitions for patients receiving antithrombotic therapy, the [[Bleeding Academic Research Consortium]] ([[BARC]]) was convened comprising representatives from different fields of medicine. These standardized definitions will help researchers determine the relative safety of different antithrombotic therapies. These definitions are recommended for both clinical trials and registries<ref name="pmid21670242">{{cite journal| author=Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J et al.| title=Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the bleeding academic research consortium. | journal=Circulation | year= 2011 | volume= 123 | issue= 23 | pages= 2736-47 | pmid=21670242 | doi=10.1161/CIRCULATIONAHA.110.009449 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21670242 }} </ref>.
| | | [[Bleeding Academic Research Consortium|BARC bleeding criteria]] |
| | | [[Exsanguination]] |
| | | [[TIMI bleeding criteria]] |
| | | [[International Society on Thrombosis and Haemostasis bleeding scale|ISTH bleeding scale]] |
| | | [[GUSTO bleeding criteria]] |
| | | [[CURE bleeding criteria]] |
| | | [[ACUITY HORIZONS bleeding criteria]] |
| | | [[STEEPLE bleeding criteria]] |
| | | [[PLATO bleeding criteria]] |
| | | [[GRACE bleeding criteria]] |
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| ==[[Causes]] == | | ===Bleeding by Location=== |
| | | ====Bleeding from Body Cavities==== |
| ==[[First aid]] == | | * [[Hematemesis]] - vomiting fresh blood |
| All people who have been injured should receive a thorough assessment. It should be divided into a primary and secondary survey and performed in a stepwise fashion, following the "[[ABC (medical)|ABC]]s". Notification of [[Emergency medical services|EMS]] or other rescue agencies should be performed in a timely manner and as the situation requires.
| | * [[Hematochezia]] - rectal blood |
| | | * [[Hematuria]] - blood in the urine from urinary bleeding |
| The '''primary survey''' examines and verifies that the patient's '''A'''irway is intact, that s/he is '''B'''reathing and that '''C'''irculation is working. A similar scheme and mnemonic is used as in [[Cardiopulmonary resuscitation|CPR]]. However, during the pulse check of '''C''', attempts should also be made to control bleeding and to assess perfusion, usually by checking [[capillary refill]]. Additionally a persons mental status should be assessed ('''D'''isability) or either an [[AVPU]] scale or via a formal [[Glasgow Coma Scale]]. In all but the most minor cases, the patient should be '''E'''xposed by removal of clothing and a secondary survey performed, examining the patient from head to toe for other injuries. The survey should not delay treatment and transport, especially if a non-correctable problem is identified.
| | * [[Hemoptysis]] - coughing up blood from the lungs |
| | | * [[Postpartum hemorrhage]] |
| === Minor bleeding === | | * [[Upper gastrointestinal bleed]] |
| | | * [[Vaginal bleeding]] |
| Minor bleeding is bleeding that falls under a Class I hemorrhage and the bleeding is easily stopped with pressure.
| | ====Internal Bleeding==== |
| | | * [[Aneurysm]] |
| The largest danger in a minor wound is [[infection]]. Bleeding can be stopped with direct pressure and elevation, and the wound should be washed well with soap and water. A dressing, typically made of gauze, should be applied. [[Hydrogen peroxide|Peroxide]] or [[iodine]] solutions (such as [[Betadine]]) can injure the cells that promote healing and may actually impair proper wound healing and delay closure.<ref>Waston, JR ''et al.'' Adv Skin Wound Care. 2005 Sep;18(7):373-8. PMID: 16160464</ref>
| | * [[Intracranial hemorrhage]] - bleeding in the brain caused by the rupture of a blood vessel within the head. See also [[hemorrhagic stroke]]. |
| | | * [[Subarachnoid hemorrhage]] (SAH) implies the presence of blood within the [[subarachnoid space]] from some pathologic process. The common medical use of the term SAH refers to the nontraumatic types of hemorrhages, usually from rupture of a berry aneurysm or [[arteriovenous malformation]](AVM). The scope of this article is limited to these nontraumatic hemorrhages. |
| === Emergency Bleeding Control ===
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| {{main|Emergency bleeding control}}
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| Severe bleeding poses a very real risk of death to the casualty if not treated quickly. Therefore, preventing major bleeding should take priority over other conditions, save failure of the heart or lungs. Most protocols advise the use of direct pressure, rest and elevation of the wound above the heart to control bleeding.
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| The use of a [[tourniquet]] is not advised in most cases, as it can lead to unnecessary [[necrosis]] or even loss of a limb. Tourniquets should rarely be used as it is usually possible to stop bleeding by the application of manual pressure.
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| === Bleeding from body cavities ===
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| The only minor situation is a spontaneous [[Epistaxis|nosebleed]], or a nosebleed caused by a slight trauma (such as a child putting his finger in his nose).
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| Simultaneous externalised bleeding from the ear may indicate brain trauma if there has been a serious head injury. Loss of consciousness, amnesia, or fall from a height increases the likelihood that there has been a severe injury. This type of injury can also be found in motor vehicle accidents associated with death or severe injury to other passengers.
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| [[Hemoptysis]], or coughing up blood, may be a sign that the person is at risk for serious bleeding. This is especially the case for patients with cancer. [[Hematemesis]] is vomiting up blood from the stomach. Often, the source of bleeding is difficult to distinguish and usually requires detailed assessment by an emergency physician.
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| === Internal bleeding ===
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| {{main|Internal bleeding}}
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| Internal bleeding occurs entirely within the confines of the body and can be caused by a medical condition (such as [[aortic aneurysm]]) or by trauma. Symptoms of internal bleeding include pale, clammy skin, an increased heart rate and a stupor or confused state.
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| The most recognizable form of internal bleeding is the [[contusion]] or bruise.
| | ==[[Bleeding causes|Causes]]== |
| | * Drug such as [[Aprotinin]], [[Azficel-T]], [[Cabozantinib]], [[Ixabepilone]], [[Oritavancin]], [[Romiplostim]], [[Tiagabine]], [[Trametinib]], [[Valdecoxib]], [[Ziv-aflibercept]] |
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| === Risk of blood contamination === | | ==Treatment== |
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| | ===[[Emergency Bleeding Control]]=== |
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| Because skin is watertight, there is no immediate risk of infection to the aide from contact with blood, provided the exposed area has not been previously wounded or diseased. Before any further activity (especially eating, drinking, touching the eyes, the mouth or the nose), the skin should be thoroughly cleaned in order to avoid cross contamination.
| | ===[[Discontinuation, bridging, and reversal of anticoagulation and antiplatelet therapy|Discontinuation, Bridging, and Reversal of Anticoagulation and Antiplatelet Therapy]]=== |
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| To avoid any risk, the hands can be prevented from contact with a glove (mostly [[latex]] or [[nitrile rubber]]), or an improvised method such as a plastic bag or a cloth. This is taught as important part of protecting the rescuer in most first aid protocols.
| | ====Contraindicated medications==== |
| | {{MedCondContrAbs|MedCond = Active major bleeding|Bivalirudin|Reteplase|Rivaroxaban|Urokinase|Cilostazol|Enoxaparin|Fondaparinux}} |
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| Following contact with blood, some rescuers may choose to go to the [[emergency department]], where [[post-exposure prophylaxis]] can be started to prevent blood-borne infection.
| | ===[[Perioperative bleeding|Perioperative Bleeding]]=== |
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| == As a medical treatment ==
| | [[Perioperative bleeding coagulation monitoring|Coagulation Monitoring]] |
| Before the advent of modern medicine the technique of [[bloodletting]], or phlebotomy, was used for a number of conditions: causing bleeding intentionally to remove a controlled amount of excess or "bad" blood. Phlebotomy is still used as an extremely effective treatment for [[Haemochromatosis]].
| | | [[Perioperative bleeding anemia management|Anemia Management]] |
| | | | [[Perioperative bleeding coagulation management|Coagulation Management]] |
| == References ==
| | | [[Perioperative bleeding management in specific surgeries|Specific Surgeries]] |
| {{Reflist}}
| | | [[Prevention and treatment of perioperative bleeding in patients with coagulopathies|Coagulopathies]] |
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| == See also ==
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| * [[Aneurysm]]
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| * [[Coagulation]]
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| * [[Upper gastrointestinal bleed]]
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| * [[Vaginal bleeding]]
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| * [[Intracerebral hemorrhage]] - bleeding in the brain caused by the rupture of a blood vessel within the head. See also [[hemorrhagic stroke]].
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| * [[Subarachnoid hemorrhage]] (SAH) implies the presence of blood within the [[subarachnoid space]] from some pathologic process. The common medical use of the term SAH refers to the nontraumatic types of hemorrhages, usually from rupture of a berry aneurysm or [[arteriovenous malformation]](AVM). The scope of this article is limited to these nontraumatic hemorrhages.
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| * [[Intracranial hemorrhage]]
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| * [[Cerebral hemorrhage]]
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| * [[Postpartum hemorrhage]]
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| * [[Hematuria]] - blood in the urine from urinary bleeding
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| * [[Hemoptysis]] - coughing up blood from the lungs
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| * [[Hematemesis]] - vomiting fresh blood
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| * [[Hematochezia]] - rectal blood
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| * [[Exsanguination]] - death by bleeding
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| <br>
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| {{SIB}}
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| [[Category:Medical emergencies]] | | [[Category:Medical emergencies]] |
| [[Category:Blood]] | | [[Category:Blood]] |
| [[Category:Hematology]] | | [[Category:Hematology]] |
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| [[bg:Кръвоизлив]]
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| [[bs:Krvarenje]]
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| [[ca:Hemorràgia]]
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| [[cs:Krvácení]]
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| [[de:Blutung]]
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| [[es:Hemorragia]]
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| [[eu:Odoljario]]
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| [[fr:Hémorragie]]
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| [[it:Emorragia]]
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| [[he:דימום]]
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| [[la:Haemorrhagia]]
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| [[lt:Kraujavimas]]
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| [[nl:Versterkte bloedingsneiging]]
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| [[ja:出血]]
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| [[pl:Krwotok]]
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| [[pt:Hemorragia]]
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| [[ro:Hemoragie]]
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| [[qu:Yawar apariy]]
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| [[ru:Кровотечение]]
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| [[sv:Blödning]]
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| {{WH}}
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| {{WS}}
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