Localized bleeding: ulcerated wound, fungating tumor, bleeding from vessel in hollow organ
Generalized: from platelet dysfunction, thrombocytopenia or coagulation disorder
Localized bleeding:
Exclude systemic causes that could be contributing: NSAIDS (stop), Vitamin K deficiency due to liver failure (Vitamin K 5-10mg s.c. or p.o.)
Visible vessel: clamp and ligate or cauterize
Multiple sites of vascular bed:
- Pressure dressings:
- Topical hemostatic agents:
- Tranexamic acid: 500mg tab dissolved in saline, soaked in gauze and applied with pressure
- epinephrine 1:1000: apply to site with gauze and pressure
- Radiotherapy
Bleeding from large vessel in hollow organ (bladder, rectum, lung): treatment specific to organ
Generalized bleeding:
Severe bleeding: intervention depends on clinical situation, illness trajectory and patient goals of care
Systemic measures: (also used for intractable localized or localized that is not amenable to local measures)
Vitamin K 5-10mg s.c. or p.o. if INR elevated
Tranexamic acid: 1.5gm stat then 500-1000 tid. Discontinue 1 week after bleeding stopped or reduce to 500mg tid.
Platelet transfusion if appropriate