Goals of therapy in common bleeding emergencies.
Acute hemorrhage is a medical emergency requiring immediate attention, regardless of whether it manifests as blood volume lost and inadequate oxygen delivery, or as a pathologic space-occupying lesion capable of exerting elevated organ-damaging pressures. The most commonly encountered and challenging hemorrhagic emergencies to manage include bleeding secondary to traumatic injury, intracranial hemorrhage, severe gastrointestinal bleeding, and diffuse intraoperative bleeding. The critical steps taken to locate, assess, and arrest bleeding in each of these circumstances can take various paths. For all of them, the basic principles of treatment are the same: identify and correct the anatomic source and restore normal hemostatic function. The agents used to accomplish these goals, however, may differ. Several typical clinical scenarios and the evidence-based approaches used to manage such cases are presented.
Dutton
Richard P
RP
Department of Trauma Anesthesiology, Shock Trauma Center, University of Maryland, Baltimore, Maryland 21201, USA. rdutton@umaryland.edu
D000328:Adult; D000368:Aged; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D001803:Blood Transfusion; D002543:Cerebral Hemorrhage / Q000628:therapy; D004630:Emergencies; D019317:Evidence-Based Medicine; D005167:Factor VII / Q000627:therapeutic use; D015942:Factor VIIa; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006487:Hemostasis; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D014947:Wounds and Injuries / Q000150:complications*
D000933:Antifibrinolytic Agents; D001779:Blood Coagulation Factors; D011994:Recombinant Proteins; C025667:prothrombin complex concentrates; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa