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:

  1. Pressure dressings:
  2. Topical hemostatic agents:
    1. Tranexamic acid: 500mg tab dissolved in saline, soaked in gauze and applied with pressure
    2. epinephrine 1:1000: apply to site with gauze and pressure
  3. 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